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HSV Encephalitis

Most common cause of sporadic fatal encephalitis worldwide — emergent acyclovir saves brain and life

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is HSV Encephalitis?

HSV encephalitis is a necrotizing hemorrhagic encephalitis with predilection for the temporal and inferior frontal lobes, predominantly caused by HSV-1 reactivation in adults and HSV-2 in neonates.

Pathogenesis involves trigeminal/olfactory pathway entry, viral replication and immune-mediated necrosis with perivascular inflammation and hemorrhagic foci.

Diagnosis combines clinical syndrome, lymphocytic CSF with elevated protein and red cells, positive HSV PCR, and MRI showing asymmetric T2/FLAIR hyperintensity in temporal lobes; EEG shows lateralized periodic discharges (PLEDs).

Symptoms

Fever and severe headache
Acute altered consciousness or behavioral change
Focal seizures, especially temporal
Aphasia or memory disturbance
Focal neurological deficits

Risk Factors

Any age but bimodal (children and over 50)
Immunocompromised state may modify presentation
Reactivation of latent HSV-1
HSV-2 vertical transmission in neonates
Prior orolabial herpes (variable association)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Acute fever with altered mental status
  • First seizure with confusion
  • Sudden language or memory disturbance
  • Focal weakness with headache and fever
  • Neonate with seizures, lethargy or vesicles

Treatment Methods

01
Empiric intravenous acyclovir 10 mg/kg every 8 hours immediately
02
Lumbar puncture with HSV PCR and culture
03
Brain MRI for temporal-lobe involvement
04
EEG to detect periodic discharges and seizures
05
Anti-seizure medication and ICU support as needed
06
Continue acyclovir 14-21 days; consider repeat PCR before stopping

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Enfeksiyon Hastalıkları Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.