No abstract available.
Diagnosis* ; Encephalitis, Herpes Simplex* ; Herpes Simplex*

Herpes Simplex Encephalitis is associated with a high mortality rate and a high probability of neurological sequelae. Good results are obtained when Herpes Simplex Encephalitis is promptly diagnosed and treated with antiviral agents. We reported a case of Herpes Simplex Encephalitis in which Magnetic Resonance Imaging (MRI), Single Photon Emission Computed Tomography (SPECT) and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) were performed sequentially. Imaging studies are valuable tools for early detection and diagnosis of Herpes Simplex Encephalitis. And particularly FDG-PET represents functional anatomy through diffuse decline of glucose metabolism better than other imaging studies.
Antiviral Agents ; Diagnosis ; Encephalitis, Herpes Simplex* ; Glucose ; Herpes Simplex* ; Magnetic Resonance Imaging* ; Metabolism ; Mortality ; Tomography, Emission-Computed, Single-Photon*

We retrospectively analyzed the MR findings of 12 patients with herpes simplex encephalitis (HSE) (8 months 64 years old). MR imaging was performed on either a 0.5T (6 patients) or 2.0T (6 patients) superconducting unit with spin echo pulse sequence. The most common and characterristic MR finding consisted of non-hemorrhgic lesions in the cortices of the temporal lobes(12), and insula(6), either bilateral(7) or unilateral(5). The frontal lobe and cingulate gyrus were involved in 4 and 2 patients respectively. Petechial hemorrhge was found in 3 patients. Non-hemorrhagic lesions were shown as high signal intensities on proton and T2WI,and iso-or low signal intensities on T1WI. In conclusion, MR imaging findings described above appear to be characteristic of HSE and were found to be extremely valuable in the diagnosis of HSE.
Diagnosis ; Encephalitis, Herpes Simplex* ; Frontal Lobe ; Gyrus Cinguli ; Herpes Simplex* ; Humans ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies

Focal brainstem encephalitis due to Herpes simplex virus if a very rare infectious disease, occurs with a frequent of 1-2 million population per year. A 3 years old girl is described with infection due to Herpes simplex virus causing brainstem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responsed to Herpes simplex virus. The clinicopathological features, radiological findings, laboratories and brainstem biopsies are discussed in the context of the literature.
Biopsy ; Brain Stem* ; Cerebrospinal Fluid ; Child, Preschool ; Communicable Diseases ; Diagnosis ; Encephalitis* ; Female ; Herpes Simplex* ; Humans ; Simplexvirus*

Petechial cortical hemorrhages are common in Herpes simplex virus (HSV) encephalitis, however, cerebral hematoma is extremely rare. We report a case of a 47-year-old immunocompetent woman diagnosed with herpes encephalitis but complicated by cerebral hematoma despite of early diagnosis and treatment.
Acyclovir ; Early Diagnosis ; Encephalitis ; Encephalitis, Herpes Simplex ; Female ; Hematoma ; Hemorrhage ; Humans ; Meningoencephalitis ; Methylmethacrylates ; Middle Aged ; Polystyrenes ; Simplexvirus

BACKGROUND: Herpes simplex virus encephalitis (HSVE) is a severe disease resulting in high mortality rates and residual sequelae; therefore, early diagnosis and treatment are very important. The purpose of this study was to evaluate the usefulness of polymerase chain reaction (PCR) assay of HSV DNA in cerebrospinal fluid (CSF) from patients with encephalitis for confirmatory diagnosis of herpes simplex virus encephalitis. MATERIALS AND METHODS: PCR analysis was done to detect DNA of HSV in 31 CSF samples obtained from 21 patients with encephalitis, admitted between November 1994 and June 1996, at the Seoul National University Children's Hospital. As controls, 15 samples from patients with proven diseases other than encephalitis were tested. Two different 22 bp- rimers, complementary to sequences within the DNA polymerase regions of HSV gene, were used. After amplification, PCR products were digested with DdeI to confirm the sequence. RESULTS: Three CSF specimens from 2 out of 21 patients with encephalitis were positive for HSV DNA, whereas all the control specimens were negative. PCR was positive in CSF samples obtained at 3 and 7 days after onset of symptoms from one patient and at 5 days from the other. PCR analysis yielded negative results in CSF samples collected at 10 and 14 days after acyclovir treatment. CONCLUSION: In this study, HSVE was diagnosed by PCR amplification of HSV genome from CSF obtained at early stage of the disease from patients with encephalitis. PCR assay of CSF samples could be used for early and confirmatory diagnosis of HSVE.
Acyclovir ; Cerebrospinal Fluid ; Diagnosis* ; DNA ; Early Diagnosis ; Encephalitis ; Genome ; Herpes Simplex* ; Humans ; Mortality ; Polymerase Chain Reaction* ; Seoul ; Simplexvirus*

Herpes simplex encephalitis is the most common form of encephalitis, but herpes simplex virus type 2 (HSV-2) encephalitis is very rare during pregnancy. In immunocompetent patients, HSV-2 encephalitis is usually mild. With early diagnosis and prompt initiation of antiviral treatment, as well as enhanced neurocritical care, a favorable outcome can be expected in both mother and neonate. We report a rare case of maternal HSV-2 encephalitis diagnosed by polymerase chain reaction following appendectomy. The woman had no symptomatic genital lesion, and the infant was not infected.
Appendectomy ; Early Diagnosis ; Encephalitis* ; Encephalitis, Herpes Simplex ; Female ; Herpesvirus 2, Human* ; Humans ; Infant ; Infant, Newborn ; Mothers ; Polymerase Chain Reaction ; Pregnancy ; Simplexvirus ; Skin*

Herpes simplex virus type I (HSV-I) causes an acute necrotizing encephalitis that selectively affects tempioral and frontal lobes. The sequelae and mortality of herpes simplex encephalitis(HSE) may be reduced by available antiviral therapy and therefore early diagnosis of HSE is essential. We have assessed the potential of brain perfusion scintigraphy using Tc-99m-HMPAO single photon emission computed tomoglaphy(SPECT) in HSE. Nine Tc-99m-HMPAO SPECTs were performed in eight patients with clinically suspected herpes simplex encephalitis. The examinations were made between 18 days and 10 months after onset of encephalitic symptoms The SPECT images in seven patients revealed decreased accumulation ol radioactivity in the affected temporal, frontal or parietal lobes. In a 30 yr-old female patient, two SPECT images were obtained on 18th day after the onset of symptoms and 3 months later. Her initial SPECT showed increased accumulation of radioactivity in the affected temporal and inferior frontal lobes. 3 month later follow-up SPECT image revealed the decreased radioactivity in the affected temporal, inferior frontal, and inferior parietal lobes. We found that the SPECT done at early stage of HSE may show increased cerebral perfusion due to inflammatory or other pathologic mechanism and the later stage SPECT may show decreased cerebral perfusion due to decreased cerebral metabolism caused by neuronal death We suggest that Tc-99m-HMPAO SPECT may support the clinical diagnosis of HSE.
Brain ; Diagnosis ; Early Diagnosis ; Encephalitis, Herpes Simplex ; Female ; Follow-Up Studies ; Frontal Lobe ; Herpes Simplex ; Humans ; Leukoencephalitis, Acute Hemorrhagic ; Metabolism ; Mortality ; Neurons ; Parietal Lobe ; Perfusion ; Perfusion Imaging ; Radioactivity ; Simplexvirus ; Tomography, Emission-Computed, Single-Photon*

Neonatal herpes simplex virus (HSV) encephalitis is a rare disease nowadays because of prenatal screening test and management. It shows progressive central nervous system manifestations affecting predominantly temporal and frontal lobes. Early diagnosis of HSV encephalitis is important since even with the early initiation of high-dose intravenous acyclovir therapy, it results in serious morbidity among survivors. A 14-day-old neonate with fever and poor oral intake was admitted via emergency department. The next day she had seizures and the brain was damaged with permanent sequelae despite of early administration of intravenous acyclovir on day 2 of admission. We report a serious case of HSV encephalitis diagnosed as type 2 HSV by polymerase chain reaction and culture of a newborn without proper prenatal screening test.
Acyclovir ; Brain ; Central Nervous System ; Early Diagnosis ; Emergency Service, Hospital ; Encephalitis* ; Fever ; Frontal Lobe ; Herpes Simplex ; Herpesvirus 2, Human* ; Humans ; Infant, Newborn* ; Mothers* ; Polymerase Chain Reaction ; Prenatal Diagnosis* ; Rare Diseases ; Seizures ; Simplexvirus ; Survivors

OBJECTIVETo summarize the clinical characteristics and long-term prognosis of herpes simplex virus encephalitis (HSE) in childhood and to analyze genotype of UNC93B1 and TLR3.

METHODData of a total of 30 HSE patients admitted to Beijing Children's Hospital from January 2008 to September 2013 were retrospectively analyzed, the data included clinical manifestations, physical sign, auxiliary examination, therapy and long-term clinical prognosis. The family history obtained during follow-up visit was also analyzed for genetic predisposition. With parents' agreement, the blood specimens of patients were collected in EDTA anticoagulant tubes, the first 2 genetic etiologies UNC93B1 and TLR3 were sequenced, and the genetic susceptibility to HSE in childhood was summarized.

RESULT(1) All the 30 patients (100%) had fever, 28 (93%) had seizure, 25 (83%) had altered state of consciousness, only 11 (37%) had personality changes, and in 8 (73%) appeared at or after 2 weeks of onset . (2) During the long-term follow up, 2 (7%) patients died after discharge, 23 patients (82%) had neurological sequelae, 13 patients (57%) had moderate, severe disability and vegetative state. (3) After sequencing of UNC93B1, and TLR3, one patient was found homozygous for a single-nucleotide substitution at position C.414C>G in exon 4 of UNC93B1 which affected the expression of UNC93B1, and may block or decrease the production of interferon. (4) Six single nucleotide polymorphisms (SNPs) were found in this study, their genotype frequency and gene frequency of Chinese were respectively searched in Genomes Project in NCBI and defined 1 000 genomes group. The genotype frequency of UNC93B1 rs7149 between 1 000 genomes group and HSE group was significantly different (χ² = 55.37, P<0.05). The frequency of CC type and C type was higher in HSE group, both of them had significant difference (χ² = 93.90, P<0.05, OR=61.563; χ² = 134.40, P<0.05, OR=12.491).

CONCLUSIONHSE lacks specific clinical manifestations, the long-term prognosis is poor. One HSE patient carrying a heterozygous mutation in UNC93B1 which may lead to the susceptibility to HSE and had harmful effect on long-term prognosis. The SNP UNC93B1 rs7149 may also have relationship with susceptibility to HSE and the children carrying CC genotype or C gene in this gene site maybe more susceptible to HSE.

Child ; Encephalitis, Herpes Simplex ; diagnosis ; genetics ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Membrane Transport Proteins ; genetics ; Mutation ; Polymorphism, Single Nucleotide ; Prognosis ; Retrospective Studies ; Toll-Like Receptor 3 ; genetics