eMedicine Specialties > Radiology > Brain/Spine

Herpes Encephalitis: Multimedia

Author: Mahesh R Patel, MD, Chief, MRI, Department of Diagnostic Imaging, Santa Clara Valley Medial Center
Contributor Information and Disclosures

Updated: Feb 24, 2009

Multimedia

Axial proton density–weighted image in a 62...
(Enlarge Image)
Media file 1: Axial proton density–weighted image in a 62-year-old woman with confusion and herpes encephalitis shows T2 hyperintensity involving the right temporal lobe.
[ CLOSE WINDOW ]
Axial proton density–weighted image in a 62...

Axial proton density–weighted image in a 62-year-old woman with confusion and herpes encephalitis shows T2 hyperintensity involving the right temporal lobe.

Axial nonenhanced T1-weighted image shows cortica...
(Enlarge Image)
Media file 2: Axial nonenhanced T1-weighted image shows cortical hyperintensity (arrows) consistent with petechial hemorrhage. In general, this is a common pathologic finding but less commonly depicted in herpes encephalitis.
[ CLOSE WINDOW ]
Axial nonenhanced T1-weighted image shows cortica...

Axial nonenhanced T1-weighted image shows cortical hyperintensity (arrows) consistent with petechial hemorrhage. In general, this is a common pathologic finding but less commonly depicted in herpes encephalitis.

Axial gadolinium-enhanced T1-weighted image revea...
(Enlarge Image)
Media file 3: Axial gadolinium-enhanced T1-weighted image reveals enhancement of the right anterior temporal lobe and parahippocampal gyrus. At the right anterior temporal tip is a hypointense, crescentic region surrounded by enhancement consistent with a small epidural abscess.
[ CLOSE WINDOW ]
Axial gadolinium-enhanced T1-weighted image revea...

Axial gadolinium-enhanced T1-weighted image reveals enhancement of the right anterior temporal lobe and parahippocampal gyrus. At the right anterior temporal tip is a hypointense, crescentic region surrounded by enhancement consistent with a small epidural abscess.

Axial diffusion-weighted image reveals restricted...
(Enlarge Image)
Media file 4: Axial diffusion-weighted image reveals restricted diffusion in the left medial temporal lobe consistent with herpes encephalitis. This patient also had a positive result on polymerase chain reaction assay for herpes simplex virus, which is both sensitive and specific. In addition, the patient had periodic lateralized epileptiform discharges on EEG, which supports the diagnosis of herpes encephalitis.
[ CLOSE WINDOW ]
Axial diffusion-weighted image reveals restricted...

Axial diffusion-weighted image reveals restricted diffusion in the left medial temporal lobe consistent with herpes encephalitis. This patient also had a positive result on polymerase chain reaction assay for herpes simplex virus, which is both sensitive and specific. In addition, the patient had periodic lateralized epileptiform discharges on EEG, which supports the diagnosis of herpes encephalitis.

Coronal T2-weighted image reveals hyperintensity ...
(Enlarge Image)
Media file 5: Coronal T2-weighted image reveals hyperintensity in the left temporal lobe (arrows) in a distribution similar to the restricted diffusion abnormality seen in Image 4 in Multimedia. This finding is typical for herpes encephalitis. In patients with HHV6 infection, one series has noted that in addition to mesial temporal lobe abnormality, abnormal T2 hyperintensity has been seen in the insular and inferior frontal region, which may suggest the diagnosis. There are felt to be 2 typical imaging appearances: one seen in older adults involves T2 hyperintensity confined to the medial temporal lobe; in young adults, a more varied pattern has been described that includes foci of restricted diffusion with an otherwise normal MR, diffuse cortical necrosis, or small focal regions of abnormal T2 hyperintensity.
[ CLOSE WINDOW ]
Coronal T2-weighted image reveals hyperintensity ...

Coronal T2-weighted image reveals hyperintensity in the left temporal lobe (arrows) in a distribution similar to the restricted diffusion abnormality seen in Image 4 in Multimedia. This finding is typical for herpes encephalitis. In patients with HHV6 infection, one series has noted that in addition to mesial temporal lobe abnormality, abnormal T2 hyperintensity has been seen in the insular and inferior frontal region, which may suggest the diagnosis. There are felt to be 2 typical imaging appearances: one seen in older adults involves T2 hyperintensity confined to the medial temporal lobe; in young adults, a more varied pattern has been described that includes foci of restricted diffusion with an otherwise normal MR, diffuse cortical necrosis, or small focal regions of abnormal T2 hyperintensity.

MRI: Herpes encephalitis.
(Enlarge Image)
Media file 6: MRI: Herpes encephalitis.
[ CLOSE WINDOW ]
MRI: Herpes encephalitis.

MRI: Herpes encephalitis.

More on Herpes Encephalitis

Overview: Herpes Encephalitis
Imaging: Herpes Encephalitis
Follow-up: Herpes Encephalitis
Multimedia: Herpes Encephalitis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Grover D, Newsholme W, Brink N. Herpes simplex virus infection of the central nervous system in human immunodeficiency virus-type 1-infected patients. Int J STD AIDS. Sep 2004;15(9):597-600. [Medline].

  2. Harrison NA, MacDonald BK, Scott G. Atypical herpes type 2 encephalitis associated with normal MRI imaging. J Neurol Neurosurg Psychiatry. Jul 2003;74(7):974-6. [Medline].

  3. Heiner L, Demaerel P. Diffusion-weighted MR imaging findings in a patient with herpes simplex encephalitis. Eur J Radiol. Mar 2003;45(3):195-8. [Medline].

  4. Kimberlin D. Herpes simplex virus, meningitis and encephalitis in neonates. Herpes. Jun 2004;11 Suppl 2:65A-76A. [Medline].

  5. Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes. Jun 2004;11 Suppl 2:57A-64A. [Medline].

  6. Weaver S, Rosenblum MK, DeAngelis LM. Herpes varicella zoster encephalitis in immunocompromised patients. Neurology. Jan 1 1999;52(1):193-5. [Medline].

  7. Elbers JM, Bitnun A, Richardson SE, Ford-Jones EL, Tellier R, Wald RM, et al. 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].

  8. Engman ML, Adolfsson I, Lewensohn-Fuchs I, Forsgren M, Mosskin M, Malm G. Neuropsychologic outcomes in children with neonatal herpes encephalitis. Pediatr Neurol. Jun 2008;38(6):398-405. [Medline].

  9. De Tiège X, Rozenberg F, Héron B. The spectrum of herpes simplex encephalitis in children. Eur J Paediatr Neurol. Mar 2008;12(2):72-81. [Medline].

  10. Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res. Sep 2006;71(2-3):141-8. [Medline].

  11. Tyler KL. Update on herpes simplex encephalitis. Rev Neurol Dis. Fall 2004;1(4):169-78. [Medline].

  12. Midi I, Tuncer N, Midi A, Mollahasanoglu A, Konya D, Sav A. Effects of decompressive surgery on prognosis and cognitive deficits in herpes simplex encephalitis. Behav Neurol. 2007;18(4):245-9. [Medline].

  13. Brenner RP, Schaul N. Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol. Apr 1990;7(2):249-67. [Medline].

  14. Piskin N, Akduman D, Aydemir H, Celebi G, Oztoprak N. Herpes simplex virus encephalitis in pregnancy. J Matern Fetal Neonatal Med. Jun 2008;21(6):421-3. [Medline].

  15. Mejías A, Bustos R, Ardura MI, Ramírez C, Sánchez PJ. Persistence of herpes simplex virus DNA in cerebrospinal fluid of neonates with herpes simplex virus encephalitis. J Perinatol. Feb 5 2009;[Medline].

  16. Taira N, Kamei S, Morita A, Ishihara M, Miki K, Shiota H, et al. Predictors of a prolonged clinical course in adult patients with herpes simplex virus encephalitis. Intern Med. 2009;48(2):89-94. [Medline].

  17. Vossough A, Zimmerman RA, Bilaniuk LT, Schwartz EM. Imaging findings of neonatal herpes simplex virus type 2 encephalitis. Neuroradiology. Apr 2008;50(4):355-66. [Medline].

  18. Patel MR, Tse V. Diagnosis and staging of brain tumors. Semin Roentgenol. Jul 2004;39(3):347-60. [Medline].

  19. Locatelli C, Vergine G, Ciambra R. [Kluver Bucy syndrome and central diabetes insipidus: two uncommon complications of herpes simplex encephalitis]. Pediatr Med Chir. Nov-Dec 2003;25(6):442-6. [Medline].

  20. Coren ME, Buchdahl RM, Cowan FM. Imaging and laboratory investigation in herpes simplex encephalitis. J Neurol Neurosurg Psychiatry. Aug 1999;67(2):243-5. [Medline].

  21. Domingues RB, Tsanaclis AM, Pannuti CS. Evaluation of the range of clinical presentations of herpes simplex encephalitis by using polymerase chain reaction assay of cerebrospinal fluid samples. Clin Infect Dis. Jul 1997;25(1):86-91. [Medline].

  22. Domingues RB, Fink MC, Tsanaclis AM. Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci. May 7 1998;157(2):148-53. [Medline].

  23. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. Apr 1995;171(4):857-63. [Medline].

  24. Gasecki AP, Steg RE. Correlation of early MRI with CT scan, EEG, and CSF: analyses in a case of biopsy-proven herpes simplex encephalitis. Eur Neurol. 1991;31(6):372-5. [Medline].

  25. Kuker W, Nagele T, Schmidt F. Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology. Feb 2004;46(2):122-5. [Medline].

  26. Zimmerman RD, Russell EJ, Leeds NE. CT in the early diagnosis of herpes simplex encephalitis. AJR Am J Roentgenol. Jan 1980;134(1):61-6. [Medline].

  27. Benator RM, Magill HL, Gerald B. Herpes simplex encephalitis: CT findings in the neonate and young infant. AJNR Am J Neuroradiol. Jul-Aug 1985;6(4):539-43. [Medline].

  28. Herman TE, Cleveland RH, Kushner DC. CT of neonatal herpes encephalitis. AJNR Am J Neuroradiol. Sep-Oct 1985;6(5):773-5. [Medline].

  29. Gaviani P, Leone M, Mula M. Progression of MRI abnormalities in herpes simplex encephalitis despite clinical improvement: natural history or disease progression?. Neurol Sci. Jun 2004;25(2):104-7. [Medline].

  30. Kuker W, Nagele T, Schmidt F. Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology. Feb 2004;46(2):122-5. [Medline].

  31. Ohta K, Funaki M, Tanaka M. Early cerebellar involvement on diffusion-weighted magnetic resonance images in herpes simplex encephalitis. J Neurol. Aug 1999;246(8):736-8. [Medline].

  32. Schmidbauer M, Podreka I, Wimberger D. SPECT and MR imaging in herpes simplex encephalitis. J Comput Assist Tomogr. Sep-Oct 1991;15(5):811-5. [Medline].

  33. Tien RD, Felsberg GJ, Osumi AK. Herpesvirus infections of the CNS: MR findings. AJR Am J Roentgenol. Jul 1993;161(1):167-76. [Medline].

  34. Provenzale JM, vanLandingham KE, Lewis DV, Mukundan S Jr, White LE. Extrahippocampal involvement in human herpesvirus 6 encephalitis depicted at MR imaging. Radiology. Dec 2008;249(3):955-63. [Medline].

  35. Leonard JR, Moran CJ, Cross DT 3rd. MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings. AJR Am J Roentgenol. Jun 2000;174(6):1651-5. [Medline].

  36. Samann PG, Schlegel J, Muller G. Serial proton MR spectroscopy and diffusion imaging findings in HIV-related herpes simplex encephalitis. AJNR Am J Neuroradiol. Nov-Dec 2003;24(10):2015-9. [Medline].

  37. Takanashi J, Sugita K, Ishii M. Longitudinal MR imaging and proton MR spectroscopy in herpes simplex encephalitis. J Neurol Sci. Jul 1997;149(1):99-102. [Medline].

  38. Delluc A, Mocquard Y, Latour P. [Encephalopathy and acute renal failure during acyclovir treatment]. Rev Neurol (Paris). Jul 2004;160(6-7):704-6. [Medline].

  39. Vidwan G, Bryant KK, Puri V. West Nile virus encephalitis in a child with left-side weakness. Clin Infect Dis. Sep 15 2003;37(6):e91-4. [Medline].

  40. Stone KM, Reiff-Eldridge R, White AD, Cordero JF, Brown Z, Alexander ER, et al. Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusions from the international acyclovir pregnancy registry, 1984-1999. Birth Defects Res A Clin Mol Teratol. Apr 2004;70(4):201-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics

 Herpes Simplex Encephalitis (Emergency Medicine)

Herpes Simplex Encephalitis (Neurology)

HIV-1 Associated Opportunistic Infections: Cytomegalovirus Encephalitis
Viral Encephalitis

Clinical guidelines

Neurologic complications in HIV-infected children and adolescents.
New York State Department of Health - State/Local Government Agency [U.S.]. 2003 Mar. 19 pages. NGC:003047

Treating opportunistic infections among HIV-infected adults and adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2004 Dec 17. 112 pages. NGC:003994

2007 national guideline for the management of genital herpes.
British Association for Sexual Health and HIV - Medical Specialty Society. 1999 Aug (revised 2007). 26 pages.  NGC:006299
 
Screening for genital herpes: recommendation statement.
United States Preventive Services Task Force - Independent Expert Panel. 2005 Mar 18. 11 pages. NGC:004067

Viral encephalitis: a review of diagnostic methods and guidelines for management.
European Federation of Neurological Societies - Medical Specialty Society. 2005 May. 13 pages. NGC:005163

Clinical trials
Long Term Treatment of Herpes Simplex Encephalitis (HSE) With Valtrex

Structure of the Herpes Simplex Virus Receptor

[ CLOSE WINDOW ]

Keywords

herpes encephalitis, viral encephalitis, herpesvirus infection, HSV encephalitis, HSV-1, HSV-2, herpes-induced encephalitis, herpes infection, brain herpes, herpes simplex virus type 1, herpes simplex virus type 2, herpes simplex virus encephalitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mahesh R Patel, MD, Chief, MRI, Department of Diagnostic Imaging, Santa Clara Valley Medial Center
Mahesh R Patel, MD is a member of the following medical societies: American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey L Creasy, MD, Associate Professor, Associate Section Head, Division of Neuroradiology, Director, Neuroradiology Fellowship, Department of Radiology, Vanderbilt University
Jeffrey L Creasy, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Val Runge, MD, Robert and Alma Moreton Centennial Chair in Radiology, Professor, Editor-in-Chief of Investigative Radiology, Department of Radiology, Scott and White Clinic and Hospital
Val Runge, MD is a member of the following medical societies: Society for Health and Human Values
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.