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Original Articles
Herpes Simplex Virus Encephalitis - Focus on Early Diagnosis by Magnetic Resonance Imaging-
Hyo Seok Kim1), Jee Yun Lee1), JunHee Woo1,2), Keon Se Oh3), Moo Young Ahn3), Kwang Ho Lee3), Dae Ho Kim4), Kye Hyun Kwon5), So Yung Jin5)
Department of Internal Medicine1), Hyunam Kindey Laboratory2), Department of Neurology3), Department of Radiology4) and Department of Anatomic Pathology5), Soon Chun Hyang University Hospital, Seoul, Korea
Vol.26 Num.3 (p229~236)
Background : Herpes simplex encephalitis is a rare complication of herpetic infection and the course in untreated patients is usually one of rapid deterioration over several days that progresses to coma and death. The only confirmative method of diagnosis is brain biopsy. Because prompt treatment with acyclovir can be lifesaving, early diagnosis of Herpes simplex encephalitis is essential. Many physicians prefer other methods to brain biopsy due to some complication.
Methods : We studied brain MRI(magnetic resonance imaging) as a noninvasive and early diagnostic method in eight cases of clinically suspected herpes simplex encephalitis restrospectively.
Results: Clinical symptoms are fever, headache, impaired orientation to time, person, and place, altered mental status with rapid progression to confusion and disorientation. Laboratory examination showed CSF pleocytosis especially of lymphocytes.
MRI of eight patients (especially T2-weighted images) demonstrated widespread high signals in the unilateral or bilateral temporal lobes, which is not always depicted in brain CT. Among eight patients seven improved with early administration of acyclovir, however, one patient died even though 10 days of acyclovir.
Conclusion: Brain MRI is thought to be a noninvasive diagnositc method with superiority of detecting early temporal lobe lesions consistent with herpes simplex encephalitis.
Keywords : Herpes simplex virus encephalitis, Brain MRI, T2-weighted image.