What are atypical presentations of 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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Unusual presentations occur. Both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) may produce a more subacute encephalitis, apparent psychiatric syndromes, and benign recurrent meningitis. Less commonly, HSV-1 may produce a brain stem encephalitis, and HSV-2 may produce a myelitis.

Ku et al discussed the unique presentation of HSE in a bilingual patient, who developed global aphasia for 1 language (his most recently learned language) but retained most of his birth language ability. [30]

McGrath et al reported on 4 patients with confirmed HSE, each with an anterior opercular syndrome, and observed that the syndrome (ie, paralysis of the masticatory, facial, pharyngeal, and lingual muscles) occurred as the primary manifestation of HSE in 2 patients and as part of the encephalitis picture in the other 2 patients. [31] The authors suggested that unique presentations (eg, anterior opercular syndrome), should alert the clinician to the possibility of HSE.

Mondal et al reported basal ganglia involvement in a child with HSE, demonstrating extrapyramidal symptoms. [32] Li and Sax reported HSE-associated cerebral hemorrhage in an HIV-positive person. [33]

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