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H.S.E

A Mind Odyssey

Adapted from the Family Practice Notebook.

 

Herpes simplex (HSV) encephalitis

  1. Encephalitis

    1. Epidemiology
    2. Most common cause of sporadic focal Encephalitis

    1. Aetiology
    2. Adults
      1. Herpes Simplex Virus Type I
      2. Herpes Simplex Virus Type II (rare)
    3. Neonates
      1. Perinatal Herpes Simplex Virus Type II transmission

    1. Pathophysiology
    2. Destructive lesions by HSV infection
      1. Inferior frontal lobe
      2. Anterior temporal lobe

    1. Labs
    2. CSF Culture
      1. Generally not useful

    1. Diagnosis
    2. CT Head or MRI Head imaging
      1. Characteristic frontal and temporal lobe involvement
    3. Electroencephalogram (EEG)
      1. Periodic sharp wave activity temporally
      2. Background of focal or diffuse slowing
    4. Brain biopsy
      1. Gold standard for diagnosis

    1. Management
    2. Acyclovir
      1. Dose: 10-12.5 mg/kg IV every 8 hours for 10-14 days
      2. Directions: Give dose over 60 minutes
      3. Start early to maximize best possible outcome
      4. Start empirically

    1. Complications
    2. Dementia
    3. Personality Disorder
    4. Memory loss
    5. Aphasia

    1. Prognosis
    2. Mortality: 10-40%
    3. High risk of severe residual neurologic deficit