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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:2015-2019, November-December 2003
© 2003 American Society of Neuroradiology

Case Report
BRAIN

Serial Proton MR Spectroscopy and Diffusion Imaging Findings in HIV-Related Herpes Simplex Encephalitis

Philipp G. Sämann^a, Jürgen Schlegel^b,c, Georg Müller^d, Franz Prantl^e, Christoph Emminger^d and Dorothee P. Auer^a

^a Max-Planck-Institute of Psychiatry, NMR Study Group, Munich, Germany
^b Krankenhaus München-Schwabing, Teaching Hospital, Ludwig-Maximilians-Universität, Munich, Germany
^c Department of Neuropathology, Technical University of Munich, Munich, Germany
^d Department of Infectious Diseases, Technical University of Munich, Munich, Germany
^e Department of Pathology, Technical University of Munich, Munich, Germany

Address correspondence to PD Dr. Dorothee P. Auer, Kraepelinstraße 10, 80804 Munich, Germany

Summary: We report the case of pathologically proved atypical herpes simplex encephalitis (HSE) in a 40-year-old male patient with AIDS who was followed up by MR imaging, which included diffusion-weighted imaging and proton MR spectroscopy (¹H-MRS). MR revealed sparing of hippocampi and limbic cortices, necrosis of both cingulate gyri, and cerebellar involvement. Increased diffusivity and severe metabolic alterations were compatible with biopsy findings of necrotizing inflammation. Clinical recovery corresponded with partial metabolite and diffusion normalization and a myo-inositol increase that indicated evolving gliosis formation further corroborated by immunohistochemistry results. ¹H-MRS and diffusion-weighted imaging may both support the diagnosis of HSE in patients with AIDS and help in the follow-up of necrotizing inflammation.

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