Which findings on presentation suggest herpes simplex encephalitis (HSE)?

Updated: Jul 17, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Typical findings on presentation include the following [5] :

  • Alteration of consciousness (97%)

  • Fever (92%)

  • Dysphasia (76%)

  • Ataxia (40%)

  • Seizures (38%): Focal (28%); generalized (10%)

  • Hemiparesis (38%)

  • Cranial nerve defects (32%)

  • Visual field loss (14%)

  • Papilledema (14%)

Meningeal signs may be present, but meningismus is uncommon. Unusual presentations also occur. Both HSV-1 and HSV-2 may produce a more subacute encephalitis, apparent psychiatric syndromes, and benign recurrent meningitis. Less commonly, HSV-1 may produce a brainstem encephalitis, and HSV-2 may produce a myelitis.

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