MRI deterioration in herpes simplex encephalitis despite clinical recovery.
OBJECTIVE
Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).


METHODS
We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.


RESULTS
Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.


CONCLUSIONS
The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.
Markoula
Sofia
S
Departments of Neurology, University of Ioannina, Greece. me01415@cc.uoi.gr
Giannopoulos
Sotirios
S
Pelidou
Sigliti-Henrietta
SH
Argyropoulou
Maria
M
Lagos
Georgios
G
Kyritsis
Athanassios P
AP
D000212:Acyclovir / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000821:virology*; D002540:Cerebral Cortex / Q000473:pathology; D002908:Chronic Disease / Q000188:drug therapy; D018450:Disease Progression; D020803:Encephalitis, Herpes Simplex / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006179:Gyrus Cinguli / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D020127:Recovery of Function / Q000276:immunology; D012008:Recurrence; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000927:Anticonvulsants; D000998:Antiviral Agents; D000212:Acyclovir