Herpes Simplex Encephalitis Without CSF Leukocytosis

Schlageter, Nicholas L.; Jubelt, Burk; Vick, Nicholas A.

doi:10.1001/archneur.1984.04050200117033

Cited by 20 publications

(5 citation statements)

References 20 publications

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“…2 In rare cases, the cerebrospinal fluid remains normal. 20 Areas of decreased attenuation may be seen on a CT scan obtained without the administration of contrast material. In one early study, CT scans became abnormal in all eight patients between the third and eighth day after the onset of symptoms 21 ; in another study, CT scans were normal in all five patients one to seven days after the onset.…”

Section: The New England Journal Of Medicinementioning

confidence: 99%

Case 1-1998

Riviello¹,

Ruoff²

1998

N Engl J Med

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Section: The New England Journal Of Medicinementioning

confidence: 99%

Case 1-1998

Riviello¹,

Ruoff²

1998

N Engl J Med

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“…In the present study, 8(38%) of the 21 CSF samples drawn between days 1 and 5 of illness showed < 10 WBC/μl. It's noteworthy that although CSF pleocytosis is usually present in about 97% of cases [17], it may be absent in either immunocompetent [9,25] or immunocompromised patients [26]. Also the presence of RBC, following a non-traumatic lumbar puncture, is encountered with similar frequency in patients with encephalitis due to other causes [17].…”

Section: Discussionmentioning

confidence: 99%

A Study on Herpes Simplex Encephalitis in 18 Children, Including 3 Relapses

Salih¹,

Khashab²,

Hassan³

et al. 2009

TOPEDJ

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Background: Herpes Simplex Virus (HSV) is the most common cause of acute sporadic focal encephalitis. Early Diagnosis is, therefore, crucial for predicting outcome. Improved laboratory technology and improved neuroimaging accessibility have enhanced our ability to diagnose this condition. Aims:To assess the reliability of different investigative tools in diagnosing and subsequent management of herpes simplex encephalitis (HSE); as well as the impact of infection and its relapse on the outcome of a cohort of 18 children evaluated during a period of 13 years.Methods: This combined prospective and retrospective study describes the clinical, laboratory, electroencephalographic and diagnostic imaging studies; and outcome in a cohort of 18 children with HSE over a period of 13 years. It also details the clinical and diagnostic features of 3 patients who relapsed. Results:The commonest initial presenting symptoms and signs were fever (100%), seizures (72%) irritability (50%) and weakness/hemiparesis (39%). Cerebrospinal fluid (CSF) pleocytosis was found in 62%, red blood cells (RBCs) >10x10 6 /L in 81% and raised proteins (>0.59g/L) in 52%. Examination for herpes simplex virus (HSV) by polymerase chain reaction (PCR) was positive in 50% (6/12). Electroencephalographic changes were universally abnormal (17/17; 100%) and periodic lateralization discharges (PLEDS) were seen in 35% (6/17). During the acute stage (days 1-8 from symptom onset), magnetic resonance imaging (MRI) revealed abnormalities in 91% (10/11), cranial computed tomography (CT) in 50% (5/10) and single photon emission computed tomography (SPECT), within < 7 days, in 75% (6/8). All patients were treated with intravenous acyclovir. There were no deaths but 3 patients relapsed after periods ranging between 18 days and 66 months. Eleven (61%) patients had no or minor sequelae (good outcome) and 7 (39%) had moderate or severe sequelae (poor outcome). Delayed initiation of therapy (> 3days from onset of symptoms) had significant association with poor outcome (P = 0.002). Initial negative PCR results may become positive on subsequent CSF specimen. Conclusion:Diagnosis of HSE requires combined clinical, laboratory, electroencephalographic and neuroimaging studies. Negative results of PCR do not exclude the infection and should not interrupt the treatment. Early diagnosis and initiation of treatment minimize the devastating effect of HSE. Full course treatment with acyclovir for 21 days is also crucial for prognosis and prevention of subsequent relapse.

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“…Die Zellzahl in der Zerebrospinalflüssigkeit einiger Patienten war kurz nach Ausbruch der Erkrankung normal, was die Diagnose erschwerte. Selten kann die Liquorzellzahl während des gesamten Krankheitsverlaufs normal bleiben (23,90). Die Laktatkonzentration war in den meisten Liquorproben leicht erhöht.…”

Section: Diskussionunclassified

Virale Enzephalitiden

Büttner¹,

Dorndorf²

1988

Fortschr Neurol Psychiatr

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Clinical symptoms, course of disease, cerebrospinal fluid (CSF) and cranial CT of 53 patients suffering from acute or subacute encephalitis were evaluated retrospectively. The virus could be identified in 21 (39%) patients. Nine of them had herpes simplex virus-encephalitis. 16 patients, eight with herpes simplex virus-encephalitis, died due to the disease. Complete restitution could be observed in 73% of survivors. Disturbance of consciousness and severe focal neurological deficit worsened prognosis towards letality and functional recovery. Most patients had initially elevated number of cellular elements and/or pathological protein concentration in CSF. CSF protein profile showed disturbance of blood-CSF-barrier function in a great number of patients during the first week of the disease whereas autochthonous production of immunoglobulin G was observed predominantly during the second and third week. Elevated concentration of CSF-lactate was seen in herpes simplex virus-encephalitis and in letal cases. 28 (53%) patients had pathological CT-findings. Generalized brain edema, focal hypodensities, focal and cortical contrast enhancement and hemorrhagic imbibation were observed. With one exception patients with herpes simplex virus-encephalitis had hypodense lesions in the temporal lobe. Besides this CT-findings did not allow conclusions regarding the etiology of encephalitis. Prognosis of encephalitis caused by other than herpes simplex virus was worse in case of pathological CT.

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Herpes Simplex Encephalitis Without CSF Leukocytosis

Cited by 20 publications

References 20 publications

Case 1-1998

Case 1-1998

A Study on Herpes Simplex Encephalitis in 18 Children, Including 3 Relapses

Virale Enzephalitiden

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