title: Herpes simplex virus encephalitis in pregnancy - a case report and review of reported patients in the literature.
abstract: BACKGROUND
  Herpes simplex virus (HSV) encephalitis is the most common sporadic cause of encephalitis with significant morbidity and mortality that is drastically reduced by early antiviral treatment.
  
  
  METHODS
  We report a 37 year old woman, 33 weeks pregnant, who presented with seizures due to proven HSV-1 encephalitis, and who had had a previous episode of probable viral encephalitis aged 14 years. She was successfully treated with aciclovir on both occasions and, in the latter, went on to deliver a healthy infant. This case is compared with 17 cases of HSV encephalitis in pregnancy in the literature identifying a predominance in the late 2nd and 3rd trimesters, perhaps in part due to immunological changes in pregnancy. The clinical presentation is also compared with non-pregnant patients with HSV encephalitis in the largest prospective UK and European studies. We also present practical advice on management from recent national guidelines.
  
  
  CONCLUSIONS
  When pregnant women present with new seizures, headache, impaired consciousness or altered behaviour urgent investigation is required to identify common diagnoses, such as eclampsia, venous sinus thrombosis and metabolic disturbances. Nevertheless, viral encephalitis is a very treatable cause of this presentation with potentially serious complications if missed, and may be more common in latter stages of pregnancy. Encephalitis should not be discounted if the patient is afebrile, has a normal Glasgow coma score, or the cerebrospinal fluid white cell count is only slightly elevated, as these features are well recognised in viral encephalitis.
authors.affiliation: Royal Preston Hospital, Sharoe Green Lane North, Preston, PR2 9HT, UK. katywhiteway@doctors.org.uk.|The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool, L9 7JL, UK. katywhiteway@doctors.org.uk.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Dodd
authors.affiliation: The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool, L9 7JL, UK. benedict.michael@liv.ac.uk.|Institute of Infection and Global Health, University of Liverpool, The Ronald Ross Building, West Derby Street, Liverpool, L69 7BE, UK. benedict.michael@liv.ac.uk.
authors.forename: Benedict D
authors.initials: BD
authors.lastname: Michael
authors.affiliation: The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool, L9 7JL, UK. Besa.Ziso@thewaltoncentre.nhs.uk.
authors.forename: Besa
authors.initials: B
authors.lastname: Ziso
authors.affiliation: Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK. Bode.Williams@lwh.nhs.uk.
authors.forename: Bode
authors.initials: B
authors.lastname: Williams
authors.affiliation: Vaccine Evaluation Unit, Public Health England, Oxford Road, Manchester, M13 9WZ, UK. Ray.Borrow@phe.gov.uk.
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
authors.affiliation: The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool, L9 7JL, UK. anita.krishnan@thewaltoncentre.nhs.uk.
authors.forename: Anita
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool, L9 7JL, UK. tsolomon@liverpool.ac.uk.|Institute of Infection and Global Health, University of Liverpool, The Ronald Ross Building, West Derby Street, Liverpool, L69 7BE, UK. tsolomon@liverpool.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
mesh_terms: D000293:Adolescent; D000328:Adult; D020803:Encephalitis, Herpes Simplex / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D055815:Young Adult