Herpes Simplex Encephalitis: An Uncommon PresentationCorrespondence Address :
Dr. Nidhi Kaeley,
Assistant Professor, Department of Medicine, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, India.
Herpes Simplex Virus (HSV) encephalitis is an uncommon illness, with about 2 cases per 250,000 per year. Most are caused by HSV-1, with 10% having HSV-2 as the aetiologic factor. We present a case of Herpes simplex type1encephalitis in a 70 year old male with an uncommon presentation. The patient was a known case of endogenous depression with no medical records and on no treatment for the same, reported with acute changes in mental state for the past five days. He was talking irrelevantly, had hallucinations and was unduly aggressive and violent. He was subjected to a thorough clinical and diagnostic work-up which included cerebrospinal fluid analysis, CT head and MRI brain. MRI brain was suggestive of mild subdural effusion which hinted towards infectious cause of encephalitis. The cerebrospinal fluid viral serology panel detected herpes simplex type 1 virus (HSV1) that was later confirmed by CSF Polymerase Chain Reaction (PCR) technique. Hence, acyclovir was initiated by intravenous route at a dosage of 10mg/kg body weight and continued for two weeks. This case holds significance in view of the fact that organic causes must be excluded in suspected cases of psychiatric illness especially in the absence of fever. Also, CSF-PCR testing plays a pivotal role in diagnosing herpes simplex encephalitis.
Psychosis, Polymerase chain reaction, Subdural effusion, Viral encephalitis
Nidhi Kaeley, Sunil Bansal, Rohan Bhatia, Sohaib Ahmad. HERPES SIMPLEX ENCEPHALITIS:
AN UNCOMMON PRESENTATION. Journal of Clinical and Diagnostic Research [serial online] 2016 May [cited: 2018 Jul 20 ]; 10:OD25-OD26. Available from
Date of Submission: Jan 24, 2016
Date of Peer Review: Feb 11, 2016
Date of Acceptance: Feb 22, 2016
Date of Publishing: May 01, 2016
Financial OR OTHER COMPETING INTERESTS: None.
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