title: A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology.
abstract: OBJECTIVE
  To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy.
  
  
  METHODS
  The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting.
  
  
  RESULTS
  Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids.
  
  
  CONCLUSIONS
  This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.
authors.affiliation: Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.|Tropical and Infectious diseases Unit, Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom.|NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom.
authors.forename: Sylviane
authors.identifier: http://orcid.org/0000-0002-4729-7505
authors.initials: S
authors.lastname: Defres
authors.affiliation: The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.|The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Keller
authors.affiliation: The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom.
authors.forename: Kumar
authors.initials: K
authors.lastname: Das
authors.affiliation: Florey Institute of Neuroscience and mental health, Heidelberg, Victoria, Australia.|Department of Anatomy and Neuroscience, University of Melbourne, Victoria, Australia.
authors.forename: Rishma
authors.initials: R
authors.lastname: Vidyasagar
authors.affiliation: Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Parkes
authors.affiliation: The department of Biostatistics, Institute of translational medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Girvan
authors.initials: G
authors.lastname: Burnside
authors.affiliation: Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.|Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Griffiths
authors.affiliation: Institute of Psychiatry, Kings College London, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Kopelman
authors.affiliation: Medical Physics and Imaging Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Roberts
authors.affiliation: Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.|NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom.|The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D020803:Encephalitis, Herpes Simplex / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D018139:Simplexvirus / Q000472:pathogenicity; D013702:Temporal Lobe / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000821:virology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000212:Acyclovir