Cognitive and learning strategies for longstanding temporal lobe lesions in a child who suffered from Herpes simplex virus encephalitis: a case study over 10 years. Authors: Van Schoor, A.N. Naude, H. Naude, H. Van Rensburg, M. Van Rensburg, M. Pretorius, E. Pretorius, E. Boon, J.m. Boon, J.m. Human Memory: Erin Allemeier

Abstract:  This article represents a case study indicating the herpes simplex virus (HSV) encephalitis may cause permanent learning disabilities due to damage to the temporal lobes. The cause study is one that shows the results extending over 10 years which determines the long-term effects on both the anatomy of the brain as well as intellectual functioning of the subject. MRI scans were taken of the subject during the initial HSV encephalitis infection and subsequently six months after recovery. An IQ test was given to determine the damage 10 years later. The results showed impairment of STM, verbal memory, and visual memory.

Who was this person and what went wrong?  8 year old South African male  Hospitalized after complaining of a severe headache, neck stiffness, as well as visual hallucinations.  Diagnosed with a viral encephalitis  7 days after initial onset of viral infection, cranial MRI scans were taken and the diagnoses of severe HSV encephalitis was made.

HSV encephalitis  The most common form and gravest of acute encephalitis.  There are about 2000 reported instances of HSV encephalitis in the United States, percent of those cases are fatal.  Patients who survive are left with serious neurological abnormalities.

What was the nature of the damage; what was impaired?  On transverse and coronal MRI scans, diffuse edema of the temporal lobe was clearly visible.  This was due to the HSV infection of the brain tissue.  Bilateral edema of both the gray and white matter of the insular cortex was seen.  Bilateral lesions of the medial temporal lobes and subcortical structures.  No damage to the hippocampus or mammillary bodies was noted. There appeared to be no hemorrhage present

 After the rapid recovery of the patient, the mother noted that the subject still seemed emotionally labile.  Stubbornness, pseudo-independence, social indifferences, and other marked emotional and behavioral changes were displayed by the subject.  MRI scans done 6 months after infection displayed the following (as seen below):bilateral lesions of the medial temporal lobes on both the transverse and coronal images.

 10 years after the viral infection, the subject was recalled to have a final MRI performed.  The 2 lesions seen 6 months after the onset of the virus were still present and unchanged.  The subject’s performance on subtest Story Memory was 10.0; this showed marked impairment of STM. This test measures short term auditory memory, as well as sustained attention to auditory stimuli.

What were the results over time?  During the subsequent follow up investigations, it was clear that the subject continued to excel in both academic and extracurricular activities at school.  He did, however, reveal impairment of auditory functioning due to the temporal lobe damage.  No forms in therapy were mentioned in the case study.

What was unclear with the case study?  The case study did not show how drastic or the improvement of the subject was.  How the patient contracted the illness would have also been of useful information.  What would have been some useful ways to improve the memory of those suffering from the same virus?