eMedicine Specialties > Neurology > Neurological Infections

Herpes Simplex Encephalitis: Follow-up

Author: Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center
Contributor Information and Disclosures

Updated: Sep 2, 2009

Follow-up

Further Inpatient Care

  • ICU care may be required, especially if seizure activity or increased intracranial pressure is present.
  • Hospitalization is not routine for uncomplicated HSV-1 or HSV-2 infection.

Further Outpatient Care

  • Depending on the neurologic deficits, rehabilitation services may be required after HSE.
  • Education may help reduce spread of HSV-2.

Inpatient & Outpatient Medications

If chronic suppressive therapy is needed, acyclovir or famciclovir can be used orally.

Complications

  • Common sequelae among survivors include motor deficits, seizure disorders, and changes in mental status.
  • If treatment of HSE is delayed, permanent neurological deficits may occur in survivors.
  • Even in treated cases of HSE, complications and sequelae are not uncommon.
  • Both focal and global sequelae may occur, and survivors may require permanent assistance.
  • Cognitive and memory deficits are particularly common, as are recurrent seizures.

Prognosis

  • Anterograde memory often is impaired even with successful treatment of HSE.
  • Retrograde memory, executive function, and language ability also may be impaired. A study by Utley et al showed that patients who had a shorter delay (<5 d) between presentation and treatment had better cognitive outcomes.16

Patient Education

For excellent patient education resources, visit eMedicine's Teeth and Mouth Center and Brain and Nervous System Center. Also, see eMedicine's patient education articles Oral Herpes, Cold Sores, and Encephalitis.

Miscellaneous

Medicolegal Pitfalls

  • Because delayed diagnosis increases morbidity and mortality, failure to diagnose and treat early could result in litigation. With the availability of potentially beneficial therapy, initiating treatment before a definitive diagnosis of HSE (ie, during the workup) should be considered. However, the literature demonstrates that even with appropriate therapy, significant morbidity is the rule rather than the exception.
  • The belief that HSV-2 lesions appear initially 2 wk after primary infection can lead to false accusations of infidelity. The physician should emphasize that initial outbreak of lesions may occur at any time, possibly years, after infection.
 


More on Herpes Simplex Encephalitis

Overview: Herpes Simplex Encephalitis
Differential Diagnoses & Workup: Herpes Simplex Encephalitis
Treatment & Medication: Herpes Simplex Encephalitis
Follow-up: Herpes Simplex Encephalitis
References
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References

  1. Wasay M, Mekan SF, Khelaeni B, et al. Extra temporal involvement in herpes simplex encephalitis. Eur J Neurol. Jun 2005;12(6):475-9. [Medline].

  2. Whitley RJ, Soong SJ, Dolin R, et al. Adenine arabinoside therapy of biopsy-proved herpes simplex encephalitis. National Institute of Allergy and Infectious Diseases collaborative antiviral study. N Engl J Med. Aug 11 1977;297(6):289-94. [Medline].

  3. Elbers JM, Bitnun A, Richardson SE. A 12-year prospective study of childhood herpes simplex encephalitis: is there a broader spectrum of disease?. Pediatrics. Feb 2007;119(2):e399-407. [Medline].

  4. Shelley BP, Raniga SB, Al-Khabouri J. An unusual late complication of intracerebral haematoma in herpes encephalitis after successful acyclovir treatment. J Neurol Sci. Jan 31 2007;252(2):177-80. [Medline].

  5. Marschitz I, Rodl S, Gruber-Sedlmayr U. Severe chorea with positive anti-basal ganglia antibodies after herpesencephalitis. J Neurol Neurosurg Psychiatry. Jan 2007;78(1):105-7. [Medline].

  6. Ku A, Lachmann EA, Nagler W. Selective language aphasia from herpes simplex encephalitis. Pediatr Neurol. Sep 1996;15(2):169-71. [Medline].

  7. McGrath NM, Anderson NE, Hope JK, et al. Anterior opercular syndrome, caused by herpes simplex encephalitis. Neurology. Aug 1997;49(2):494-7. [Medline].

  8. Mondal G, Kumar R, Ghosh JK, Basu K, Chatterjee S. Basal ganglia involvement in a child with herpes simplex encephalitis. Indian J Pediatr. May 27 2009;[Medline].

  9. Li JZ, Sax PE. HSV-1 encephalitis complicated by cerebral hemorrhage in an HIV-positive person. AIDS Read. Apr 2009;19(4):153-5. [Medline].

  10. Mitchell BM, Stevens JG. Neuroinvasive properties of herpes simplex virus type 1 glycoprotein variants are controlled by the immune response. J Immunol. Jan 1 1996;156(1):246-55. [Medline].

  11. Geiger KD, Nash TC, Sawyer S, et al. Interferon-gamma protects against herpes simplex virus type 1-mediated neuronal death. Virology. Nov 24 1997;238(2):189-97. [Medline].

  12. Cathomas R, Pelosi E, Smart J. Herpes simplex encephalitis as a complication of adjuvant chemotherapy treatment for breast cancer. Clin Oncol (R Coll Radiol). Jun 2005;17(4):292-3. [Medline].

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  14. Beneto A, Gomez E, Rubio P, et al. [Periodical EEG pattern modifications in herpetic encephalitis treated with acyclovir]. Rev Neurol. Jul 1996;24(131):829-32. [Medline].

  15. [Best Evidence] Glenny AM, Fernandez Mauleffinch LM, Pavitt S, Walsh T. Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer. Cochrane Database Syst Rev. Jan 21 2009;CD006706. [Medline].

  16. Utley TF, Ogden JA, Gibb A, et al. The long-term neuropsychological outcome of herpes simplex encephalitis in a series of unselected survivors. Neuropsychiatry Neuropsychol Behav Neurol. Jul 1997;10(3):180-9. [Medline].

  17. Athmanathan S, Vydehi BV. Neuronal apoptosis in herpes simplex virus-1 encephalitis (HSE). Medical Microbiology. 2001;19:127-131.

  18. Baxter P, Forsyth R, Eyre J. Relapse and movement disorder after herpes simplex encephalitis. J Child Neurol. Jun 1997;12(4):283. [Medline].

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  21. Hasegawa T, Kanno S, Kato M, et al. Neuro-Behçet's disease presenting initially as mesiotemporal lesions mimicking herpes simplex encephalitis. Eur J Neurol. Aug 2005;12(8):661-2. [Medline].

  22. Jereb M, Lainscak M, Marin J, Popovic M. Herpes simplex virus infection limited to the brainstem. Wien Klin Wochenschr. Jul 2005;117(13-14):495-9. [Medline].

  23. Preiser W, Weber B, Klos G, et al. Unusual course of herpes simplex virus encephalitis after acyclovir therapy. Infection. Sep-Oct 1996;24(5):384-9. [Medline].

  24. Shian WJ, Chi CS. Magnetic resonance imaging of herpes simplex encephalitis. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. Jan-Feb 1996;37(1):22-6. [Medline].

  25. Whitley RJ. Viral encephalitis. N Engl J Med. Jul 26 1990;323(4):242-50. [Medline].

  26. Whitley RJ, Soong SJ, Linneman C Jr, et al. Herpes simplex encephalitis. Clinical Assessment. JAMA. Jan 15 1982;247(3):317-20. [Medline].

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Further Reading

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Keywords

herpes, genital herpes, herpes encephalitis, encephalitis, HSE, HSV-1, HSV-2, cold sores, fever blisters, herpes simplex virus, human herpesvirus, HHV, HHV-1, herpes simplex virus type 1, herpes simplex virus type 2, herpes simplex encephalitis

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Contributor Information and Disclosures

Author

Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center
Wayne E Anderson, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Law Medicine and Ethics, California Medical Association, and San Francisco Medical Society
Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Consulting

Medical Editor

Ramon Diaz-Arrastia, MD, PhD, Assistant Professor, Department of Neurology, Comprehensive Epilepsy Center, University of Texas Southwestern
Ramon Diaz-Arrastia, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, New York Academy of Sciences, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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