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Herpes Encephalitis Type 1
Surjith Vattoth, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Herpes simplex encephalitis (HSE)
              • Definitions

                • Older children and adults: Brain parenchyma infection caused by herpes simplex virus type 1 (HSV1)
                • Typically reactivation in immunocompetent patients
                • Neonates and infants: HSV2

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Gayretli Aydin ZG et al: Acyclovir unresponsive herpes simplex encephalitis in a child successfully treated with the addition of Foscarnet: case report. Arch Argent Pediatr. 117(1):e47-51, 2019
                                            2. Rabinstein AA: Herpes virus encephalitis in adults: current knowledge and old myths. Neurol Clin. 35(4):695-705, 2017
                                            3. Hatanpaa KJ et al: Neuropathology of viral infections. Handb Clin Neurol. 123:193-214, 2014
                                            4. Mahan M et al: Neuroimaging of viral infections of the central nervous system. Handb Clin Neurol. 123:149-73, 2014
                                            5. Steiner I et al: Update on herpes virus infections of the nervous system. Curr Neurol Neurosci Rep. 13(12):414, 2013
                                            6. Studahl M et al: Acute viral infections of the central nervous system in immunocompetent adults: diagnosis and management. Drugs. 73(2):131-58, 2013
                                            7. Ibitoye RT et al: Pitfalls in the management of herpes simplex virus encephalitis. BMJ Case Rep, 2012
                                            8. Sureka J et al: Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review. Br J Radiol. 85(1017):e782-92, 2012
                                            9. Akyldz BN et al: Diffusion-weighted magnetic resonance is better than polymerase chain reaction for early diagnosis of herpes simplex encephalitis: a case report. Pediatr Emerg Care. 24(6):377-9, 2008
                                            10. Baringer JR: Herpes simplex infections of the nervous system. Neurol Clin. 26(3):657-74, viii, 2008
                                            11. Bulakbasi N et al: Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am. 18(1):53-84; viii, 2008
                                            12. Hatipoglu HG et al: Magnetic resonance and diffusion-weighted imaging findings of herpes simplex encephalitis. Herpes. 15(1):13-7, 2008
                                            13. Kataoka H et al: Early dynamic SPECT imaging in acute viral encephalitis. J Neuroimaging. 17(4):304-10, 2007
                                            14. Obeid M et al: Diffusion-weighted imaging findings on MRI as the sole radiographic findings in a child with proven herpes simplex encephalitis. Pediatr Radiol. 37(11):1159-62, 2007
                                            15. Rimon A et al: West Nile encephalitis mimicking herpes encephalitis. Pediatr Neurol. 35(1):62-4, 2006
                                            16. Whitley RJ: Herpes simplex encephalitis: adolescents and adults. Antiviral Res. 71(2-3):141-8, 2006
                                            17. Duckworth JL et al: Magnetic resonance restricted diffusion resolution correlates with clinical improvement and response to treatment in herpes simplex encephalitis. Neurocrit Care. 3(3):251-3, 2005
                                            18. Kuker W et al: Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology. 46(2):122-5, 2004
                                            19. Kaga K et al: Auditory agnosia in children after herpes encephalitis. Acta Otolaryngol. 123(2):232-5, 2003
                                            20. Sämann PG et al: Serial proton MR spectroscopy and diffusion imaging findings in HIV-related herpes simplex encephalitis. AJNR Am J Neuroradiol. 24(10):2015-9, 2003
                                            21. Cakirer S et al: MR imaging in epilepsy that is refractory to medical therapy. Eur Radiol. 12(3):549-58, 2002
                                            22. Bash S et al: Mesiotemporal T2-weighted hyperintensity: neurosyphilis mimicking herpes encephalitis. AJNR Am J Neuroradiol. 22(2):314-6, 2001
                                            23. Kleinschmidt-DeMasters BK et al: The expanding spectrum of herpesvirus infections of the nervous system. Brain Pathol. 11(4):440-51, 2001
                                            24. Teixeira J et al: Diffusion imaging in pediatric central nervous system infections. Neuroradiology. 43(12):1031-9, 2001
                                            25. Leonard JR et al: MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings. AJR Am J Roentgenol. 174(6):1651-5, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Herpes simplex encephalitis (HSE)
                                                        • Definitions

                                                          • Older children and adults: Brain parenchyma infection caused by herpes simplex virus type 1 (HSV1)
                                                          • Typically reactivation in immunocompetent patients
                                                          • Neonates and infants: HSV2

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Gayretli Aydin ZG et al: Acyclovir unresponsive herpes simplex encephalitis in a child successfully treated with the addition of Foscarnet: case report. Arch Argent Pediatr. 117(1):e47-51, 2019
                                                                                      2. Rabinstein AA: Herpes virus encephalitis in adults: current knowledge and old myths. Neurol Clin. 35(4):695-705, 2017
                                                                                      3. Hatanpaa KJ et al: Neuropathology of viral infections. Handb Clin Neurol. 123:193-214, 2014
                                                                                      4. Mahan M et al: Neuroimaging of viral infections of the central nervous system. Handb Clin Neurol. 123:149-73, 2014
                                                                                      5. Steiner I et al: Update on herpes virus infections of the nervous system. Curr Neurol Neurosci Rep. 13(12):414, 2013
                                                                                      6. Studahl M et al: Acute viral infections of the central nervous system in immunocompetent adults: diagnosis and management. Drugs. 73(2):131-58, 2013
                                                                                      7. Ibitoye RT et al: Pitfalls in the management of herpes simplex virus encephalitis. BMJ Case Rep, 2012
                                                                                      8. Sureka J et al: Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review. Br J Radiol. 85(1017):e782-92, 2012
                                                                                      9. Akyldz BN et al: Diffusion-weighted magnetic resonance is better than polymerase chain reaction for early diagnosis of herpes simplex encephalitis: a case report. Pediatr Emerg Care. 24(6):377-9, 2008
                                                                                      10. Baringer JR: Herpes simplex infections of the nervous system. Neurol Clin. 26(3):657-74, viii, 2008
                                                                                      11. Bulakbasi N et al: Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am. 18(1):53-84; viii, 2008
                                                                                      12. Hatipoglu HG et al: Magnetic resonance and diffusion-weighted imaging findings of herpes simplex encephalitis. Herpes. 15(1):13-7, 2008
                                                                                      13. Kataoka H et al: Early dynamic SPECT imaging in acute viral encephalitis. J Neuroimaging. 17(4):304-10, 2007
                                                                                      14. Obeid M et al: Diffusion-weighted imaging findings on MRI as the sole radiographic findings in a child with proven herpes simplex encephalitis. Pediatr Radiol. 37(11):1159-62, 2007
                                                                                      15. Rimon A et al: West Nile encephalitis mimicking herpes encephalitis. Pediatr Neurol. 35(1):62-4, 2006
                                                                                      16. Whitley RJ: Herpes simplex encephalitis: adolescents and adults. Antiviral Res. 71(2-3):141-8, 2006
                                                                                      17. Duckworth JL et al: Magnetic resonance restricted diffusion resolution correlates with clinical improvement and response to treatment in herpes simplex encephalitis. Neurocrit Care. 3(3):251-3, 2005
                                                                                      18. Kuker W et al: Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology. 46(2):122-5, 2004
                                                                                      19. Kaga K et al: Auditory agnosia in children after herpes encephalitis. Acta Otolaryngol. 123(2):232-5, 2003
                                                                                      20. Sämann PG et al: Serial proton MR spectroscopy and diffusion imaging findings in HIV-related herpes simplex encephalitis. AJNR Am J Neuroradiol. 24(10):2015-9, 2003
                                                                                      21. Cakirer S et al: MR imaging in epilepsy that is refractory to medical therapy. Eur Radiol. 12(3):549-58, 2002
                                                                                      22. Bash S et al: Mesiotemporal T2-weighted hyperintensity: neurosyphilis mimicking herpes encephalitis. AJNR Am J Neuroradiol. 22(2):314-6, 2001
                                                                                      23. Kleinschmidt-DeMasters BK et al: The expanding spectrum of herpesvirus infections of the nervous system. Brain Pathol. 11(4):440-51, 2001
                                                                                      24. Teixeira J et al: Diffusion imaging in pediatric central nervous system infections. Neuroradiology. 43(12):1031-9, 2001
                                                                                      25. Leonard JR et al: MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings. AJR Am J Roentgenol. 174(6):1651-5, 2000