Markoula Sofia, Giannopoulos Sotirios, Pelidou Sigliti-Henrietta, Argyropoulou Maria, Lagos Georgios, Kyritsis Athanassios P
Departments of Neurology, University of Ioannina, Greece.
Neurologist. 2009 Jul;15(4):223-6. doi: 10.1097/NRL.0b013e3181921abc.
Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).
We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.
Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.
The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.
1型单纯疱疹病毒是病毒性脑炎的散发性病因。高达10%的患者会出现脑炎复发，表现为症状复发、临床及磁共振成像（MRI）检查结果异常，以及脑脊液（CSF）中存在1型单纯疱疹病毒DNA。
我们描述了2例单纯疱疹性脑炎急性期及脑炎发病6个月后的临床特征、MRI检查结果及预后情况。
两名患者对治疗反应良好，恢复情况极佳。尽管临床症状已恢复，但在6个月的随访中发现MRI病变与复发相符，且无任何临床症状或CSF异常。
这种MRI恶化的潜在机制尚不清楚，可能涉及免疫介导机制。因此，对单纯疱疹性脑炎后的MRI恶化应谨慎解读，它并不总是代表复发，尤其是当影像学检查结果与临床及CSF检查结果不相关时。
