Perfusion and thallium single photon emission computed tomography in herpes simplex encephalitis
Introduction
Herpes simplex encephalitis (HSE) typically includes a rapid onset syndrome characterized by fever, headache, seizures, focal neurological signs and impaired consciousness. Previous reports (see [12]) have shown the contributory diagnostic relevance of MRI and demonstrated the superiority of MRI over CT, especially in the early course of HSE. Changes of 99mTc-HMPAO distribution have also been reported to contribute to diagnosis and follow-up in HSE 9, 8). We describe a 77-year-old woman with proven HSE and, for the first time in the literature, compare MRI and 99mTc-HMPAO SPECT findings with 201Tl-SPECT observations.
Section snippets
Case report
A 77-year-old woman was transferred to our hospital, 1 week after admission to a peripheral hospital, with high fever (≥39°C), generalized tonic-clonic seizures, deterioration of mental state, impaired consciousness and meningeal signs. The CT scan of the brain performed on the day of admission to our institution after administration of contrast was suggestive of an ischemic lesion in the territory of the right posterior cerebral artery (not indicative of meningoencephalitis). Cerebrospinal
Discussion
MRI has been proven to be beneficial in the early diagnosis of HSE 9, 11, 3, 10. This was also the case for the presented patient, 10 days after the beginning of the symptoms. A correlation between the time of onset of herpes simplex seroconversion and PCR positiveness is not possible, since these examinations were only performed later in the course of the disease. As reported before, most viruses including herpes simplex and herpes zoster virus hijack physiologic receptors to infect host
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