title: A study on viral CNS inflammation beyond herpes encephalitis.
abstract: The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather "benign" disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.
authors.affiliation: Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany. berit.jordan@medizin.uni-halle.de.
authors.forename: Berit
authors.initials: B
authors.lastname: Jordan
authors.affiliation: Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Kösling
authors.affiliation: Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Emmer
authors.affiliation: Dermatology Outpatient Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Koch
authors.affiliation: Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Müller
authors.affiliation: Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kornhuber
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism; D001931:Brain Mapping; D002644:Chickenpox / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D020031:Epstein-Barr Virus Infections / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D005260:Female; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018139:Simplexvirus / Q000302:isolation & purification
keywords: CSF; Diffusion-weighted MRI; Herpes simplex virus; Varizella zoster virus; Viral encephalitis