herpes simplex encephalitis a report of 16 cases from eastern india

Sixteen cases of Herpes simplex Encephalitis (HSE) from Eastern India seen over a period of five years (1996-2001) are reported. Selection criteria included clinical features, characteristic MRI changes and positive immunological test. CT scans, EEG and CSF findings supported the diagnosis. Altered sensorium and seizure were the two commonest presenting features. Other presentations included behaviour abnormality, personality change, speech disturbance and hemiparesis. The onset of neurological symptoms was preceded by a prodrome of fever and headache in 80% patients. CT scan was abnormal in50% cases. Typical MRI changes, key point for diagnosis consisted of T2 weighted hyper intensities involving the temporal and frontal lobes. EEG showed focal periodic discharges over temporal lobes in 6 cases and non-specific slowing in5. Commonest CSF abnormalities noted in our series were moderate pleocytosis and raised protein. All reported cases showed presence of antibody against herpes simplex virus (HSV) in CSF. Presence of RBC in CSF and absence of hypoglychorrea were important diagnostic indicators. The response to treatment with acyclovir was satisfactory. All our patients survived. Six out of 16 our patients had moderate to severe neurological deficits at the time of discharge.