Imaging Spectrum of Herpes Encephalitis In Paediatric Brain Abstract IDNo: 90

Case 1: 11 yrs old female child who presented with fever of 6 days duration and two generalized tonic–clonic seizures. MR imaging on 1.5-T magnet was performed 7 days after symptom onset.

MR images:

 T2 & FLAIR hyperintensities involving bilateral inferior frontal lobe, perinsular cortex and left medial temporal lobe and posterior corpus callosum. - Features consistent with hemorrhagic herpetic encephalitis. MR Shows:

Same patient came after 18 months with similar episode and MR was performed MR shows:  Well cortically enhancing T2 hyperintense lesions in the bilateral inferior frontal cortex and insular cortex with cortical swelling.  Massive non enhancing edema involving the left supratentorial white matter, basal ganglia causing mass effect and midline shift with subfalcine herniation. - possibility of recurrent atypical form of herpes encephalitis

 Chronic Granulomatous Herpes Simplex – Encephalitis. Pt undergone biopsy and biopsy was proven to be:

Patient was treated and follow up MR was done: Compares to the previous one, present MRI show,  Same pattern of enhancing lesion with mild reduced mass effect & midline shift. -- Chronic Herpes Simplex – Encephalitis.

Case 2: 9-month-old female infant who presented with fever, lethargy, generalized tonic–clonic seizures one episode and decreased oral intake of 3 days duration. Initial MR images on 1.5-T magnet were performed 5 days after symptom onset.

MR Images:  Bilateral symmetric diffusion restricted lesions in the anterior temporal region, frontoparietal region and lateral aspect of thalamus (geniculate bodies). - features suggestive of Herpes simplex encephalitis.

Pt was treated and follow up MR in 20 days shows:  Bilateral symmetric gliosis foci in the anterior temporal region& superior temporal gyri& periinsular cortex.Chronic areas of hemorrhagic with gliosis in the lateral aspect of both thalamus (geniculate bodies). - No new lesions.

Case 3: 5-month-old male infant who presented with upper respiratory symptoms and fever of 4 days duration and single focal motor seizure on day of admission. MR imaging with 1.5-T magnet was performed 5 days after symptom onset.

 Cortical swelling with areas of hemorrhages in the left frontoparietal cortex and left anterior temporal cortex. s/o hemorrhagic encephalitis – Possible herpes encephalitis.

2-month-old male infant who presented with fever of 4 days duration and single focal motor seizure on day of admission. MR imaging with 1.5-T magnet was performed 3 days after symptom onset. Case 4:

 Bilateral asymmetrical diffusion restriction lesion involving both mesial temporal, uncus, hippocampal, basifrontal, left anterolateral temporal, bilateral periinsula, left posterior thalamic, genu of corpus callosum and posterior temporal region. - features suggestive of herpes encephalitis. MR shows:

Follow up MR shows: -- No focal lesion or gliotic changes.

References:  M. A. ADAMO, L. ABRAHAM, AND I. F. POLLACK, “CHRONIC GRANULOMATOUS HERPES ENCEPHALITIS: a rare entity posing a diagnostic challenge,” Journal of Neurosurgery, vol. 8, pp. 402–406,  WILLIAM B. RADCLIFFE, FAUSTINO C. GUINTO, DAVID F. ADCOCK, MARTIN R. KRIGMAN: American Journal of Roentgenology. 1971;112: /ajr WILLIAM B. RADCLIFFEFAUSTINO C. GUINTODAVID F. ADCOCKMARTIN R. KRIGMAN

Take Home Message:  Though Herpes encephalitis appears to be treatable cause,early diagnosis and prompt treatment required to prevent permanent brain damage and its sequelae…