title: Herpes simplex virus encephalitis despite normal cell count in the cerebrospinal fluid.
abstract: OBJECTIVE
  To describe herpes simplex virus encephalitis despite normal cell count in the cerebrospinal fluid in patients with malignoma after whole brain irradiation.
  
  
  METHODS
  Blood and cerebrospinal fluid analysis and magnetic resonance imaging.
  
  
  RESULTS
  Three male and two female patients with malignoma and a recent history of whole-brain irradiation presented with impaired consciousness with or without epileptic seizure. Although cerebrospinal fluid analysis revealed a normal cell count, herpes simplex virus DNA was detected in all samples by polymerase chain reaction.
  
  
  CONCLUSIONS
  In patients with impaired consciousness, epileptic seizure, or temporal lobe symptoms of new onset and a recent history of brain irradiation with normal cerebrospinal fluid, an atypical anergic course of herpes simplex virus encephalitis should be considered. Herpes simplex virus polymerase chain reaction should be used as method of choice to detect herpes simplex virus genomes as early as possible rather than relying on routine cerebrospinal fluid parameters. Importantly, antiviral therapy should be started without delay in any case of faint suspicion and should be continued until herpes simplex virus encephalitis is clearly ruled out.
authors: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. jakob@urz.uni-hd.de
authors: Nurith J
authors: NJ
authors: Jakob
authors: Thorsten
authors: T
authors: Lenhard
authors: Paul
authors: P
authors: Schnitzler
authors: Stefan
authors: S
authors: Rohde
authors: Peter A
authors: PA
authors: Ringleb
authors: Thorsten
authors: T
authors: Steiner
authors: Brigitte
authors: B
authors: Wildemann
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid* / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D018259:Herpesvirus 1, Human; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir