Herpes simplex encephalitis: Difference between revisions
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+ | == Background == |
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+ | === Microbiology === |
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+ | * More commonly caused by [[HSV-1]] than [[HSV-2]] (which more commonly causes [[aseptic meningitis]]) |
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+ | === Pathophysiology === |
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+ | * About one-third are from primary infection while two-thirds are from reactivation of latent infection |
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+ | === Epidemiology === |
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+ | * Causes about 10% of [[encephalitis]] cases |
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+ | == Differential Diagnosis == |
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+ | * Other causes of [[encephalitis]] |
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[[Category:Herpesviridae]] |
[[Category:Herpesviridae]] |
Revision as of 18:08, 12 August 2020
Background
- Infection of the brain parenchyma by HSV, with a predilection for temporal lobes
Microbiology
- More commonly caused by HSV-1 than HSV-2 (which more commonly causes aseptic meningitis)
Pathophysiology
- About one-third are from primary infection while two-thirds are from reactivation of latent infection
Epidemiology
- Causes about 10% of encephalitis cases
Clinical Manifestations
- Fever
- Headache
- Altered level of consciousness
- Personality and behavioural changes
- Focal neuro deficits
- Seizures
- Rapidly progressing and can lead to coma
Differential Diagnosis
- Other causes of encephalitis
Investigations
- Imaging
- CT head usually normal
- MRI head can show T2 signal change in temporal lobes
- Lumbar puncture
- Elevated protein
- Lymphocytosis (10-1000 WBCs)
- Erythrocytes in 80% of cases ("hemorrhagic necrotizing meningoencephalitis")
- Normal or slightly low glucose
- HSV PCR is confirmatory
- EEG
- Spikes and slow waves over involved areas
- Periodic lateralized epiieptiform discharges (PLEDs)
- Usually predominately over involved termporal lobe
Management
- Acyclovir 10mg/kg q8h IV for 14 days
- Ensure adequate hydration and adjust for renal function