Herpes Simplex Encephalitis

Abstract

Figure 1. CT image of the brain shows high dense lesions in both temporal tips at 6 days after onset of HSE.Herpes simplex virus (HSV)causes severe acute encephalitis with occasional hemorrhagic changes in the unilateral temporal lobe. Werecently treated a case of acute herpes simplex encephalitis (HSE) with bilateral temporal lobe hemorrhage. A 55-year-old womanwas admitted to our hospital suffering from confusion and continuous headache. Neurological examination revealed meningeal sign, confusion (JCS3), endpoint nystagmus, and bilateral pathological reflexes. Magnetic resonance imaging (MRI) of the brain on admission showed a lesion in the right temporal lobe. Acute HSEwas suspected. HSVDNAwas detected in the cerebrospinal fluid by PCR tests. On the sixth day after admission, computed tomography (CT) and MRIstudies of the brain revealed hemorrhagic changes in both temporal lobes. The patient was treated with acyclovir at a dosage of 1,500 mg/day for 14 days from admission, but dementia remained. Hemorrhagic changes in both temporal lobes are atypical findings in HSEcases.