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Herpes simplex encephalitis (HSV2)

Goldstein SJG - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: University of Kentucky

ABSTRACT

Diagnosis: Herpes simplex encephalitis (HSV2)

History: 43 year old woman presents with seizure. History of 4 days of headache, nausea and vomiting

Findings: • August MRI- Mass lesion in left temporal lobe, with edema but no contrast enhancement. Best seen on FLAIR MRI. • November MRI- ring-like enhancement in left temporal lobe. FLAIR images are not remarkable

Ddx: • Tumor • Trauma • Infection - abscess vs encephalitis vs meningoencephalitis • Post-ictal changes

Dxhow: CSF positive PCR for herpes type 2

Exam: • Febrile and disoriented • Lumbar puncture requested

No MeSH data available.


Companion Case - Herpes simplex encephalitis usually affects the cortical gray matter, especially early in the disease.  Temporal lobe  and insular cortex are usually first (red outlines)- with abnormal signal intensity (bright on FLAIR and T2W), cortical thickening (sulcal effacement), and variable enhancement.  Similar changes occur in the cingulate gyrus (orange outlines) in up to 2/3 of patients.The inferior frontal gyri may be affected next.  Since vascular/ischemic lesions also affect the cortex, a non-vascular pattern of involvement (e.g. bilateral insula or insula plus cingulate) can be very helpful.  Involvement of the basal ganglia gray matter is uncommon and/or late in the course of HSV encephalitis.
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MPX2149_synpic55536: Companion Case - Herpes simplex encephalitis usually affects the cortical gray matter, especially early in the disease. Temporal lobe and insular cortex are usually first (red outlines)- with abnormal signal intensity (bright on FLAIR and T2W), cortical thickening (sulcal effacement), and variable enhancement. Similar changes occur in the cingulate gyrus (orange outlines) in up to 2/3 of patients.The inferior frontal gyri may be affected next. Since vascular/ischemic lesions also affect the cortex, a non-vascular pattern of involvement (e.g. bilateral insula or insula plus cingulate) can be very helpful. Involvement of the basal ganglia gray matter is uncommon and/or late in the course of HSV encephalitis.


Herpes simplex encephalitis (HSV2)

Goldstein SJG - MedPix (2007)

Companion Case - Herpes simplex encephalitis usually affects the cortical gray matter, especially early in the disease.  Temporal lobe  and insular cortex are usually first (red outlines)- with abnormal signal intensity (bright on FLAIR and T2W), cortical thickening (sulcal effacement), and variable enhancement.  Similar changes occur in the cingulate gyrus (orange outlines) in up to 2/3 of patients.The inferior frontal gyri may be affected next.  Since vascular/ischemic lesions also affect the cortex, a non-vascular pattern of involvement (e.g. bilateral insula or insula plus cingulate) can be very helpful.  Involvement of the basal ganglia gray matter is uncommon and/or late in the course of HSV encephalitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2149&req=5

MPX2149_synpic55536: Companion Case - Herpes simplex encephalitis usually affects the cortical gray matter, especially early in the disease. Temporal lobe and insular cortex are usually first (red outlines)- with abnormal signal intensity (bright on FLAIR and T2W), cortical thickening (sulcal effacement), and variable enhancement. Similar changes occur in the cingulate gyrus (orange outlines) in up to 2/3 of patients.The inferior frontal gyri may be affected next. Since vascular/ischemic lesions also affect the cortex, a non-vascular pattern of involvement (e.g. bilateral insula or insula plus cingulate) can be very helpful. Involvement of the basal ganglia gray matter is uncommon and/or late in the course of HSV encephalitis.

View Article: MedPix Image - MedPix Case

Affiliation: University of Kentucky

ABSTRACT

Diagnosis: Herpes simplex encephalitis (HSV2)

History: 43 year old woman presents with seizure. History of 4 days of headache, nausea and vomiting

Findings: • August MRI- Mass lesion in left temporal lobe, with edema but no contrast enhancement. Best seen on FLAIR MRI. • November MRI- ring-like enhancement in left temporal lobe. FLAIR images are not remarkable

Ddx: • Tumor • Trauma • Infection - abscess vs encephalitis vs meningoencephalitis • Post-ictal changes

Dxhow: CSF positive PCR for herpes type 2

Exam: • Febrile and disoriented • Lumbar puncture requested

No MeSH data available.