What is the role of brain biopsy in the diagnosis 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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Brain biopsy was once considered the only definitive means of diagnosing HSE. The results of brain biopsy can also establish alternative diagnoses, both treatable (eg, brain tumor) and nontreatable (eg, non-HSV viral encephalitis). Currently, with the advent of PCR technology, the role of brain biopsy is diminishing. Studies have demonstrated that PCR testing of CSF is as accurate as brain biopsy in confirming the diagnosis of HSE.

When the diagnosis of HSE cannot be established by other means (eg, when lumbar puncture is precluded or nondiagnostic), brain biopsy can yield a definitive diagnosis and may be considered. However, with the availability of nontoxic and effective antiviral medications, brain biopsy is rarely used today. The procedure carries a complication rate of about 3%.

Orbitofrontal or limbic encephalitis may be seen. One hallmark of the condition is significant hemorrhage in these locations. On pathology specimens, Cowdry A inclusions are seen.

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