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HERPES SIMPLEX ENCEPHALITIS

HERPES SIMPLEX ENCEPHALITIS. M.RASOOLINEJAD, MD DEPARTMENT OF INFECTIOUS DISEASE TEHRAN UNIVERCITY OF MEDICAL SCIENCE. HERPES SIMPLEX ENCEPHALITIS ( HSE ) A SERIOUS ILLNESS WITH SIGNIFICANT RISKS OF MORBIDITY & MORTALITY TREATABLE ENCEPHALITIS. EPIDEMIOLOGY.

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HERPES SIMPLEX ENCEPHALITIS

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  1. HERPES SIMPLEX ENCEPHALITIS M.RASOOLINEJAD, MD DEPARTMENT OF INFECTIOUS DISEASE TEHRAN UNIVERCITY OF MEDICAL SCIENCE

  2. HERPES SIMPLEX ENCEPHALITIS ( HSE ) A SERIOUS ILLNESS WITH SIGNIFICANT RISKS OF MORBIDITY & MORTALITY TREATABLE ENCEPHALITIS

  3. EPIDEMIOLOGY Incidence: 1/ 250,000 to 500,000/ year Morbidity: Untreated patients, 70% Treated patients, 19% Morbidity: > 50% of survivors are left with moderate or severe neurologic deficits Sex: In male & female is equal Age: Peaks in childhood & middle-aged

  4. HSE Acute or Subacute Illness General & Focal Cerebral Dysfunction Sporadic Without Seasonal Pattern HSV-1 in 95% cases

  5. PATHOGENESIS • Children & young adult: • Primary HSV infection Brain • Adult: • Prior HSV-1 infection ( Ab +ve ) • Reactivation in Trigeminal or • Autonomic roots • Brain Olfactory bulb

  6. PATHOLOGY Edema&Congestion&Hemorrhage&Necrosis Intense Hemorrhagic necrosis In Temporal & Frontal lobe Hallmark of HSE: Bilateral Asymmetrical Anterior Temporal lobe inflammation

  7. CLINICAL MANIFESTATIONS NO PATHOGNOMONIC CLINICAL FINDING • Typical symptoms: • Fever 90% • Headache 81% • Psychiatrics symptoms 71% • Seizures 67% • Vomiting 46% • Focal weakness 33% • Memory loss 24% • Altered mental status & photophobia

  8. CLINICAL MANIFESTATIONS NO PATHOGNOMONIC CLINICAL FINDING • Typical finding on P/E: • Alteration of consciousness 97% • Fever 92% • Dysphasia 76% • Seizures 38% (Focal 28%, General 10%) • Hemiparesis 38% • Cranial nerve defect 32% • Visual field loss 14% • Papilledema 14%

  9. DIFFERENTIAL DIAGNOSIS • Brain abscess • Epidural & Subdural abscess • Neoplasms, Brain • Pediatric febrile seizures • Stroke & Hemorrhagic or Ischemic

  10. WORK-UP • Lab Studies: • CSFMononuclear pleocytosis • Elevated protein • Nl or reduce glucose • Initial may be Nl • Hemorrhagic natureElevated RBC • HSV is rarely cultured • CSF/PCRSensitive & Specific

  11. WORK-UP Imaging Studies: • MRI ( Preferred mainly imaging ) • Bilateral Temporal & Inferior Frontal Changes • CT-Scan ( much less sensitive than MRI ) • Other tests: • EEG Focal abnormalities • Slow-wave or periodic sharp-wave • Over temporal lobe • Sensitive Not Specific

  12. TREATMENT • Goals of therapy: • Shorten the clinical course • 2.To prevent complications • To prevent subsequent recurrence

  13. TREATMENT ASYCLOVIR The drug of choice • mg/kg (or 500mg/m2 ) IV q8h • Each dose infused over 1 hour Duration: 10 to 14 days

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