Diffuse white matter lesions associated with herpes simplex encephalitis as observed on magnetic resonance imaging

doi:10.1016/0387-7604(95)00141-7

Brain and Development

Volume 18, Issue 2, March–April 1996, Pages 150-152

https://doi.org/10.1016/0387-7604(95)00141-7 Get rights and content

Abstract

A 2-year-old boy with herpes simplex encephalitis developed diffuse brain lesions involving the white matter of both cerebral hemispheres. These lesions in the white matter were clearly observed on magnetic resonance imaging (MRI) with the T2-weighted sequence, and were found to have spontaneously disappeared on subsequent MRI performed 7 weeks later. Brain lesions associated with herpes simplex encephalitis in the literature are reviewed and the pathogenesis in the present case is discussed.

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AJNR
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Cited by (18)

The spectrum of herpes simplex encephalitis in children
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Citation Excerpt :
Immune investigations, including ABGA concentration, should be performed in cases of HSE to further understand the pathophysiological mechanisms involved in this secondary neurological deterioration. A secondary immune-mediated process has also been suspected in some patients with transient or chronic white matter involvement occurring after HSE.8,99–105 These white matter lesions were described in children as in adults.
Clinical and basic science research carried out in recent years into herpes simplex encephalitis (HSE) have shown that the concept of a “classical” picture of HSE in children is now outdated and that our current knowledge of the disease is probably only the tip of an iceberg. Indeed, increasing evidence supports the existence of a wider range of pathophysiological mechanisms, clinical presentations and disease progressions in paediatric HSE. This paper reviews the clinical, biological and radiological data available and redefines the spectrum of HSE in children. Full understanding of the condition should improve the management of suspected cases and decrease the morbidity and the mortality associated with this disease.
Deterioration on Magnetic Resonance Imaging Despite Good Clinical Recovery After Viral Encephalitis
2008, Pediatric Neurology
Citation Excerpt :
Magnetic resonance imaging is the most sensitive tool for the detection of viral encephalitis, along with cerebrospinal fluid analysis for the diagnosis and detection of the causative agent. Deterioration on magnetic resonance imaging after clinical recovery was previously reported in cases of herpes simplex encephalitis, which is the most common and well-studied cause of viral encephalitis [2-6]. De Tiège et al. [2] reported herpes simplex encephalitis relapses in six children, and suggested that two different mechanisms might account for these relapses: viral replication or an immune-mediated inflammatory process.
We present a 2-year-old patient who showed progressive widespread white-matter abnormalities on magnetic resonance imaging 1 month after viral encephalitis, despite her good clinical recovery. These lesions on magnetic resonance imaging had not responded to therapies commonly used to treat secondary immune-mediated demyelinating lesions, as observed in acute disseminated encephalomyelitis. Acute viral encephalitis caused cortical blindness, but no other clinical signs developed during her clinical course. The progressive white-matter lesion in our case was different from the exacerbation of viral encephalitis or secondary immune-mediated encephalitis. A year later, magnetic resonance imaging-demonstrated brain atrophy with cystic changes in the bilateral occipital area, with remarkably reduced white-matter lesions. We hypothesize that the progressive white-matter changes resulted from the process of atrophy, degeneration, and cystic formation after viral encephalitis, rather than from the immune-mediated demyelinating process.
Postinfectious immune-mediated encephalitis after pediatric herpes simplex encephalitis
2005, Brain and Development
We report a 3-year-old patient who presented a secondary acute neurological deterioration clinically characterized by a partial Kluver–Bucy syndrome, 1 month after the onset of herpes simplex encephalitis. This episode is unlikely due to continuation or resumption of cerebral viral replication but might be related to an immune-inflammatory process. In children, postinfectious immune-mediated encephalitis occuring after HSE are usually clinically characterized by choreoathetoid movements. This type of movement disorder was, however, not observed in this patient. On the basis of this case and a review of the literature, we hypothesize the existence of a spectrum of secondary immune-mediated process triggered by herpes simplex virus cerebral infection ranging from asymptomatic cases with diffuse white matter involvement to secondary acute neurological deteriorations with or without extrapyramidal features.
Asymptomatic self-limiting white matter lesions in the chronic phase of herpes simplex encephalitis
2002, Brain and Development
We report a 9-month-old girl with herpes simplex encephalitis. T₂-weighted magnetic resonance imaging (MRI) on the 8th day of illness showed increased signal intensity in the gray and white matter of the bilateral lobes, especially the right temporo-parietal lobe. High voltage slow waves were recorded in the right parieto-occipital region on electroencephalography. She was discharged on the 34th day of illness without sequelae. On discharge, the high signal intensity on MRI had improved and the abnormal slow waves on electroencephalography had disappeared.At 4 months after the onset of illness, MRI revealed decreased signal intensities in T₁-weighted images and increased signal intensities in T₂-weighted images in the periventricular white matter adjacent to the posterior horns of the lateral ventricles. The white matter lesions had expanded at 9 months after the onset of illness. At 14 months after the onset of illness, the white matter lesions were reduced in size, and at 2 years after the onset of illness, they had completely disappeared. During 2 years follow-up after discharge, however, there were no neurological abnormalities corresponding to the lesions and her psychomotor development was normal. Although the mechanism underlying these white matter lesions had not been elucidated, an immune-mediated complication such as edema or demyelination is suspected. Repeat MRI studies over a long period are necessary to follow up a patient with herpes simplex encephalitis.
Clinical characteristics of children with cerebral white matter abnormalities
2000, European Journal of Paediatric Neurology
The rapidly expanding use of magnetic resonance imaging (MRI) in children with neurological impairments of unknown aetiology has revealed a large number of children with abnormalities of the cerebral white matter, some with leukodystrophy-like white matter abnormalities on MRI, but non-progressive in clinical presentation and course. The aim of this study was to investigate the clinical and neuroradiological characteristics of 26 children with white matter abnormalities of unknown origin and to find diagnostic clues or indicators of progressive versus non-progressive disease. The typical child with white matter abnormalities was characterized by onset of symptoms within the first year of life, most often presenting as general developmental delay and hypotonia. Later-appearing signs were spasticity and ataxia and as a rule severe learning and motor disabilities. Serious ophthalmological signs were frequently seen. Perinatal adverse events were rare, infectious aetiologies not indicated but prenatal stigmata relatively common. The clinical course was progressive in 11 children and non-progressive in 15. Late onset presentation was associated with a progressive course whereas prenatal stigmata and asymmetrical white matter lesions only were found in children with a non-progressive disorder. The MRI showed three main patterns: a) a generalized increase of the T2 signal of the white matter in 12 children, b) a bilateral, symmetric but not generalized abnormality in nine and c) asymmetric, focal or multifocal pathology in five. Useful information as to clinical entities and course was obtained from the combined clinical and radiological assessment. A precise nosological diagnosis could be made in six cases. The study showed that white matter abnormalities in children constitute a heterogeneous group of rare and `anonymous' conditions, motivating collaborative studies for further clarification of background and management.
Magnetic resonance imaging of disorders with white matter changes in children and adolescents: a pictorial essay
2023, Pediatric Radiology

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Diffuse white matter lesions associated with herpes simplex encephalitis as observed on magnetic resonance imaging

Abstract

Viral infections of the nervous system

Mild form of herpes encephalitis

J Neurol Neurosurg Psychiatry

Magnetic resonance imaging in infections of the central nervous system

AJNR