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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1133-1134

Cortical Laminar Necrosis in HSV-1 Encephalitis


Department of Neurology, Dr. RML Hospital, New Delhi, India

Date of Submission23-Dec-2019
Date of Decision09-Feb-2020
Date of Acceptance18-May-2020
Date of Web Publication2-Sep-2021

Correspondence Address:
Abhishek Juneja
A-15, Old Quarters, Ramesh Nagar, New Delhi - 110 015
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325308

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How to cite this article:
Juneja A, Anand KS. Cortical Laminar Necrosis in HSV-1 Encephalitis. Neurol India 2021;69:1133-4

How to cite this URL:
Juneja A, Anand KS. Cortical Laminar Necrosis in HSV-1 Encephalitis. Neurol India [serial online] 2021 [cited 2021 Oct 18];69:1133-4. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1133/325308




Magnetic resonance imaging (MRI) is the neuroimaging study of choice in the evaluation of encephalitis. MRI is the most sensitive and specific imaging method for herpes simplex virus encephalitis, particularly early in the course of the illness.[1] Typical findings on MRI include asymmetric hyperintense lesions on T2-weighted sequences corresponding to areas of edema in the mesiotemporal and orbitofrontal lobes and the insular cortex.[2] Common differential diagnoses to be considered are infarct and status epilepticus. Infarct follows a vascular territory besides having a distinct clinical presentation. Status epilepticus presents unilaterally and typically involves mainly the cortex with widespread postictal edema.

Accumulating evidence suggests that diffusion restriction on diffusion-weighted imaging is frequently seen early in the course of Herpes Simplex Virus Encephalitis (HSVE) and may be among the earliest neuroradiologic manifestations.[3] We had a 22-year-old male patient who had fever for 7 days followed by altered sensorium with multiple episodes of generalized tonic clonic seizures for 2 weeks. His MRI brain showed T2/fluid-attenuated inversion recovery asymmetric bilateral temporal, insular and basifrontal hyperintensities with cortical laminar necrosis in right temporal lobe [Figure 1], [Figure 2], [Figure 3]. Herpes Simplex Virus 1 (HSV 1) was detected in cerebrospinal fluid using polymerase chain reaction.
Figure 1: Fluid-attenuated inversion recovery (FLAIR) MRI sequences showing bilateral asymmetric (right > left) temporal, insular, and basifrontal hyperintensities

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Figure 2: MRI brain sequence showing diffusion restriction in bilateral temporal, insular, and basifrontal regions

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Figure 3: T1 MRI sequence showing curvilinear cortical hyperintensity involving bilateral temporal (right > left) lobe

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Conflicts of interest

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  References Top

1.
Domingues RB, Fink MC, Tsanaclis AM, de Castro CC, Cerri GG, Mayo MS, et al. Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci 1998;157:148-53.  Back to cited text no. 1
    
2.
Misra UK, Kalita J, Phadke RV, Wadwekar V, Boruah DK, Srivastava A, et al. Usefulness of various MRI sequences in the diagnosis of viral encephalitis. Acta Trop 2010;116:206-11.  Back to cited text no. 2
    
3.
Sawlani V. Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis. J Neurol Sci 2009;287:221-6.  Back to cited text no. 3
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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