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HERPES SIMPLEX
ENCEPHALITIS
M.RASOOLINEJAD, MD
DEPARTMENT OF INFECTIOUS DISEASE
TEHRAN UNIVERCITY OF MEDICAL SCIENCE
HERPES SIMPLEX ENCEPHALITIS
( HSE )
A SERIOUS ILLNESS
WITH SIGNIFICANT RISKS
OF MORBIDITY & MORTALITY
TREATABLE ENCEPHALITIS
EPIDEMIOLOGY
Incidence: 1/ 250,000 to 500,000/ year
Morbidity: Untreated patients, 70%
Treated patients, 19%
Morbidity: > 50% of survivors are left
with moderate or severe
neurologic deficits
Sex: In male & female is equal
Age: Peaks in childhood & middle-aged
HSE
Acute or Subacute Illness
General & Focal Cerebral Dysfunction
Sporadic
Without
Seasonal Pattern
HSV-1 in 95% cases
PATHOGENESIS
Children & young adult:
Primary HSV infection
Olfactory
bulb
Adult:
Prior HSV-1 infection ( Ab +ve )
Reactivation in Trigeminal or
Autonomic roots
Brain
Brain
PATHOLOGY
Edema & Congestion & Hemorrhage &Necrosis
Intense Hemorrhagic necrosis
In
Temporal & Frontal lobe
Hallmark of HSE:
Bilateral Asymmetrical
Anterior Temporal lobe inflammation
CLINICAL MANIFESTATIONS
NO PATHOGNOMONIC CLINICAL FINDING
Typical symptoms:
•Fever 90%
•Headache 81%
•Psychiatrics symptoms 71%
•Seizures 67%
•Vomiting 46%
•Focal weakness 33%
•Memory loss 24%
•Altered mental status & photophobia
CLINICAL MANIFESTATIONS
NO PATHOGNOMONIC CLINICAL FINDING
Typical finding on P/E:
•Alteration of consciousness 97%
•Fever 92%
•Dysphasia 76%
•Seizures 38% (Focal 28%, General 10%)
•Hemiparesis 38%
•Cranial nerve defect 32%
•Visual field loss 14%
•Papilledema 14%
DIFFERENTIAL DIAGNOSIS
Brain abscess
Epidural & Subdural abscess
Neoplasms, Brain
Pediatric febrile seizures
Stroke & Hemorrhagic or Ischemic
WORK-UP
Lab Studies:
CSF Mononuclear
pleocytosis
Elevated protein
Nl or reduce glucose
Initial may be Nl
Hemorrhagic natureElevated RBC
HSV is rarely cultured
CSF/PCRSensitive & Specific
WORK-UP
Imaging Studies:
MRI
( Preferred mainly imaging )
Bilateral Temporal & Inferior Frontal Changes
CT-Scan ( much less sensitive than
Other tests:
EEG Focal abnormalities
MRI )
Slow-wave or periodic sharp-wave
Over temporal lobe
Sensitive Not Specific
TREATMENT
Goals of therapy:
1.Shorten the clinical course
2.To prevent complications
1.To prevent subsequent recurrence
TREATMENT
ASYCLOVIR
The drug of choice
10mg/kg (or 500mg/m2 ) IV q8h
Each dose infused over 1 hour
Duration: 10 to 14 days