MRI Deterioration in Herpes Simplex Encephalitis Despite Clinical Recovery

作者：Markoula Sofia^*; Giannopoulos Sotirios; Pelidou Sigliti Henrietta; Argyropoulou Maria; Lagos Georgios; Kyritsis Athanassios P

来源：Neurologist, 2009, 15(4): 223-226.

DOI：10.1097/NRL.0b013e3181921abc

• herpes simplex encephalitis
• MRI findings
• outcome
• immune-mediated mechanism

Objectives: Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).
Methods: We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.
Results: Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.
Conclusions: The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.

• 出版日期2009-7