Herpesviral encephalitis

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Herpesviral encephalitis

coronal T2-weighted MR image shows high signal in the temporal lobes including
hippocampal formations and parahippogampal gyrae, insulae, and right inferior
frontal gyrus. A brain biopsy was performed and the histology was consistent with
encephalitis. PCR was repeated on the biopsy specimen and was positive for HSV

Classification and external resources

ICD-10

B00.4

ICD-9

054.3

eMedicine

article/1165183 article/341142

Herpesviral encephalitis is encephalitis due to herpes simplex virus.

Herpes simplex encephalitis (HSE) is a viral infection of the human central nervous system. It is
estimated to affect at least 1 in 500,000 individuals per year and some studies suggest an incidence
rate of 5.9 cases per 100,000 livebirths. The majority of cases of herpes encephalitis are caused by
herpes simplex virus-1 (HSV-1), the same virus thatcauses cold sores. 57% of American adults are
infected with HSV-1, which is spread through droplets, casual contact, and sometimes sexual
contact, though most infected people never have cold sores. About 10% of cases of herpes
encephalitis are due to HSV-2, which is typically spread through sexual contact. About 1 in 3 cases
of HSE result from primary HSV-1 infection, predominantly occurring in individuals under the age of
18; 2 in 3 cases occur in seropositivepersons, few of whom have history of recurrent orofacial
herpes. Approximately 50% of individuals that develop HSE are over 50 years of age.
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Contents
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1 Pathophysiology

2 Presentation

3 Treatment

4 References

5 External links

Pathophysiology[edit]
HSE is thought to be caused by the retrograde transmission of virus from a peripheral site on the
face following HSV-1 reactivation, along a nerve axon, to the brain. The virus lies dormant in
the ganglion of the trigeminal cranial nerve, but the reason for reactivation, and its pathway to gain
access to the brain, remains unclear, though changes in the immune system caused by stress
clearly play a role in animal models of the disease. The olfactory nerve may also be involved in HSE,
which may explain its predilection for the temporal lobes of the brain, as the olfactory nerve sends
branches there. In horses, a single-nucleotide polymorphism is sufficient to allow the virus to cause
neurological disease; but no similar mechanism has been found in humans.
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Presentation[edit]
Most individuals with HSE show a decrease in their level of consciousness and an altered mental
state presenting as confusion, and changes in personality. Increased numbers of white blood cells
can be found in patient's cerebrospinal fluid, without
the presence of pathogenic bacteria and fungi. Patients typically have a fever and may have
seizures. The electrical activity of the brain changes as the disease progresses, first showing
abnormalities in one temporal lobe of the brain, which spread to the other temporal lobe 710 days
later. Imaging by CT or MRI shows characteristic changes in the temporal lobes (see Figure).
Definite diagnosis requires testing of the cerebrospinal fluid (CSF) by a lumbar puncture (spinal tap)
for presence of the virus. The testing takes several days to perform, and patients with suspected
Herpes encephalitis should be treated with acyclovir immediately while waiting for test results.
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Treatment[edit]
Herpesviral Encephalitis can be treated with high-dose intravenous aciclovir. Without treatment, HSE
results in rapid death in approximately 70% of cases; survivors suffer severe neurological damage.
When treated, HSE is still fatal in one-third of cases, and causes serious long-term neurological
damage in over half of survivors. Twenty percent of treated patients recover with minor damage.
Only a small population of survivors (2.5%) regain completely normal brain function. Earlier
treatment (within 48 hours of symptom onset) improves the chances of a good recovery. Rarely,
treated individuals can have relapse of infection weeks to months later. While the herpes virus can
be spread, encephalitis itself is not infectious. Other viruses can cause similar symptoms of
encephalitis, though usually milder (human herpes virus-6, varicella zoster virus, EpsteinBarr, cytomegalovirus, coxsackievirus, etc.).
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