Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-06-16T11:11:39.140Z Has data issue: false hasContentIssue false

Case 40 - Herpes encephalitis

Published online by Cambridge University Press:  18 December 2013

Nafi Aygun
Affiliation:
The Johns Hopkins University
Gaurang Shah
Affiliation:
University of Michigan Health System
Dheeraj Gandhi
Affiliation:
University of Maryland Medical Center
Get access

Summary

Imaging description

Nearly 95% cases of herpes simplex encephalitis (HSE) are caused by herpes simplex virus 1 (HSV1), and it is the most common cause of fatal encephalitis [1,2]. Brain infection is likely a result of direct transmission of the virus from a peripheral site to the trigeminal or olfactory nerve, although other mechanisms include hematogenic transmission.

CT imaging in patients with HSE is frequently non-specific. It may reveal areas of hypodensity in the temporal or frontal lobes, but frank hemorrhage or enhancement is uncommonly seen. MRI should be obtained rapidly in patients suspected of harboring this diagnosis, since MRI can reveal the characteristic neuroanatomical pattern of involvement. Herpes encephalitis is generally unilateral in the initial phase, but there is progressive but asymmetric contralateral involvement in the later stages (Figs. 40.1, 40.2). The medial temporal and inferior frontal lobes are commonly affected, but most characteristically there is involvement of the insula (Fig. 40.1). HSE is frequently hemorrhagic, and enhancement is not a prominent feature in the early disease process. In later stages, patchy enhancement is frequently seen (Fig. 40.2C) [1]. The disease predominantly involves the cortex and subcortical white matter, and there is often extensive involvement of the limbic system.

Type
Chapter
Information
Pearls and Pitfalls in Head and Neck and Neuroimaging
Variants and Other Difficult Diagnoses
, pp. 210 - 212
Publisher: Cambridge University Press
Print publication year: 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Core, L. Spear, PG. Infection with herpes simplex viruses. Part 1. N Engl J Med 1986; 314: 686–91.CrossRefGoogle Scholar
Cruz, JCH, Domingues, RC. Intracranial infections. In Atlas, SW, ed., Magnetic Resonance Imaging of the Brain and Spine, 4th edn (ed. Atlas, SW). Philadelphia, PA: Lippincott Williams & Wilkins; 2009; pp. 929–1025.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×