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Imaging findings of neonatal herpes simplex virus type 2 encephalitis

  • Paediatric Neuroradiology
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Abstract

Introduction

The CT, MR, and diffusion-weighted initial and follow-up imaging findings in neonatal herpes simplex virus type 2 (HSV-2) encephalitis were assessed.

Methods

The clinical, laboratory and imaging findings in 12 patients (eight girls and four boys) with proven neonatal HSV-2 encephalitis with follow-up were retrospectively reviewed. Patterns of brain involvement and distribution of lesions were studied and the contribution of diffusion-weighted imaging to the imaging diagnosis of this disease was explored. A total of 24 CT and 22 MRI studies were performed with a mean follow-up time of 38 months.

Results

Neonatal HSV-2 encephalitis can be multifocal or limited to only the temporal lobes, brainstem, or cerebellum. The deep gray matter structures were involved in 57% of patients, and hemorrhage was seen in more than half of the patients. CT images were normal or showed mild abnormalities in the early stages of the disease. Conventional MR images may be normal in the early stages of the disease. Lesions were initially seen only by diffusion-weighted imaging in 20% of the patients and this modality showed a substantially more extensive disease distribution in an additional 50% of patients. In 40% of patients, watershed distribution ischemic changes were observed in addition to areas of presumed direct herpetic necrosis.

Conclusion

Neonatal HSV-2 encephalitis has a variable imaging appearance. Diffusion-weighted MRI is an important adjunct in the imaging evaluation of this disease. Watershed distribution ischemia in areas remote from the primary herpetic lesions may be seen.

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References

  1. Whitley RJ (1993) Neonatal herpes simplex virus infections. J Med Virol Suppl 1:13–21

    Article  PubMed  CAS  Google Scholar 

  2. Whitley RJ (2002) Herpes simplex virus in children. Curr Treat Options Neurol 4:231–237

    Article  PubMed  Google Scholar 

  3. Kohl S (1997) Neonatal herpes simplex virus infection. Clin Perinatol 24:129–150

    PubMed  CAS  Google Scholar 

  4. Davis JM, Davis KR, Kleinman GM, Kirchner HS, Taveras JM (1978) Computed tomography of herpes simplex encephalitis, with clinicopathological correlation. Radiology 129:409–417

    PubMed  CAS  Google Scholar 

  5. Benator RM, Magill HL, Gerald B, Igarashi M, Fitch SJ (1985) Herpes simplex encephalitis: CT findings in the neonate and young infant. AJNR Am J Neuroradiol 6:539–543

    PubMed  CAS  Google Scholar 

  6. Herman TE, Cleveland RH, Kushner DC, Taveras JM (1985) CT of neonatal herpes encephalitis. AJNR Am J Neuroradiol 6:773–775

    PubMed  CAS  Google Scholar 

  7. Noorbehesht B, Enzmann DR, Sullender W, Bradley JS, Arvin AM (1987) Neonatal herpes simplex encephalitis: correlation of clinical and CT findings. Radiology 162:813–819

    PubMed  CAS  Google Scholar 

  8. Junck L, Enzmann DR, DeArmond SJ, Okerlund M (1981) Prolonged brain retention of contrast agent in neonatal herpes simplex encephalitis. Radiology 140:123–126

    PubMed  CAS  Google Scholar 

  9. Enzmann D, Chang Y, Augustyn G (1990) MR findings in neonatal herpes simplex encephalitis type II. J Comput Assist Tomogr 14:453–457

    Article  PubMed  CAS  Google Scholar 

  10. Teixeira J, Zimmerman RA, Haselgrove JC, Bilaniuk LT, Hunter JV (2001) Diffusion imaging in pediatric central nervous system infections. Neuroradiology 43:1031–1039

    Article  PubMed  CAS  Google Scholar 

  11. Kurtz J, Anslow P (2003) Infantile herpes simplex encephalitis: diagnostic features and differentiation from non-accidental injury. J Infect 46:12–16

    Article  PubMed  CAS  Google Scholar 

  12. Fonseca-Aten M, Messina AF, Jafri HS, Sanchez PJ (2005) Herpes simplex virus encephalitis during suppressive therapy with acyclovir in a premature infant. Pediatrics 115:804–809

    Article  PubMed  Google Scholar 

  13. Kubota T, Ito M, Maruyama K, Kato Y, Miyajima Y, Ogawa A, Kuno K, Okumura A, Watanabe K (2007) Serial diffusion-weighted imaging of neonatal herpes encephalitis: a case report. Brain Dev 29:171–173

    Article  PubMed  Google Scholar 

  14. Dhawan A, Kecskes Z, Jyoti R, Kent AL (2006) Early diffusion-weighted magnetic resonance imaging findings in neonatal herpes encephalitis. J Paediatr Child Health 42:824–826

    Article  PubMed  Google Scholar 

  15. Smith MC, Lennetee EH, Reames HR (1941) Isolation of the virus of herpes simplex and the demonstration of intranuclear inclusions in a case of acute encephalitis. Am J Pathol 17:55–68

    CAS  PubMed  Google Scholar 

  16. Corey L, Whitley RJ, Stone EF, Mohan K (1988) Difference between herpes simplex virus type 1 and type 2 neonatal encephalitis in neurological outcome. Lancet 1:1–4

    Article  PubMed  CAS  Google Scholar 

  17. Hall SM, Glickman M (1990) Report from the British Paediatric Surveillance Unit. Arch Dis Child 65:807–809

    PubMed  CAS  Google Scholar 

  18. Whitley RJ (1992) Neonatal herpes simplex virus infections: pathogenesis and therapy. Pathol Biol (Paris) 40:729–734

    CAS  Google Scholar 

  19. Mindel A, Taylor J, Tideman RL (2000) Neonatal herpes prevention: a minor public health problem in some communities. Sex Transm Infect 76:287–291

    Article  PubMed  CAS  Google Scholar 

  20. Koskiniemi M, Happonen JM, Jarvenpaa AL, Pettay O, Vaheri A (1989) Neonatal herpes simplex virus infection: a report of 43 patients. Pediatr Infect Dis J 8:30–35

    Article  PubMed  CAS  Google Scholar 

  21. Kimberlin DW (2001) Advances in the treatment of neonatal herpes simplex infections. Rev Med Virol 11:157–163

    Article  PubMed  CAS  Google Scholar 

  22. Whitley RJ, Stagno S (1991) Perinatal viral infections. In: Scheld WM, Whitley RJ, Durack DT (eds) Infections of the central nervous system. Raven Press, New York, pp 167–193

    Google Scholar 

  23. Hutto C, Arvin A, Jacobs R et al (1987) Intrauterine herpes simplex virus infections. J Pediatr 110:97–101

    Article  PubMed  CAS  Google Scholar 

  24. Mikati MA, Feraru E, Krishnamoorthy K, Lombroso CT (1990) Neonatal herpes simplex meningoencephalitis: EEG investigations and clinical correlates. Neurology 40:1433–1437

    PubMed  CAS  Google Scholar 

  25. Troendle-Atkins J, Demmler GJ, Buffone GJ (1993) Rapid diagnosis of herpes simplex virus encephalitis by using the polymerase chain reaction. J Pediatr 123:376–380

    Article  PubMed  CAS  Google Scholar 

  26. Kimberlin DW, Lakeman FD, Arvin AM et al (1996) Application of the polymerase chain reaction to the diagnosis and management of neonatal herpes simplex virus disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 174:1162–1167

    PubMed  CAS  Google Scholar 

  27. Malm G, Forsgren M (1999) Neonatal herpes simplex virus infections: HSV DNA in cerebrospinal fluid and serum. Arch Dis Child Fetal Neonatal Ed 81:F24–F29

    Article  PubMed  CAS  Google Scholar 

  28. Mitchell PS, Espy MJ, Smith TF et al (1997) Laboratory diagnosis of central nervous system infections with herpes simplex virus by PCR performed with cerebrospinal fluid specimens. J Clin Microbiol 35:2873–2877

    PubMed  CAS  Google Scholar 

  29. Whitley RJ, Nahmias AJ, Soong SJ, Galasso GG, Fleming CL, Alford CA (1980) Vidarabine therapy of neonatal herpes simplex virus infection. Pediatrics 66:495–501

    PubMed  CAS  Google Scholar 

  30. Jenkins M, Kohl S (1992) New aspects of neonatal herpes. Infect Dis Clin North Am 6:57–74

    PubMed  CAS  Google Scholar 

  31. Kimberlin DW, Lin CY, Jacobs RF et al (2001) Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics 108:223–229

    Article  PubMed  CAS  Google Scholar 

  32. Kohl S (2000) Herpes simplex infection. In: Behrman RE, Kliegman R, Jenson HB (eds) Nelson textbook of pediatrics, 16th edn. W.B. Saunders, Philadelphia, pp 437–444

    Google Scholar 

  33. Enzmann DR (1986) Neonatal herpes encephalitis. AJNR Am J Neuroradiol 7:363

    PubMed  CAS  Google Scholar 

  34. Johnson BA (2000) Intracranial infections. In: Orrison W (ed) Neuroimaging. W.B. Saunders, Philadelphia, pp 767–799

    Google Scholar 

  35. Buff BL Jr, Mathews VP, Elster AD (1994) Bacterial and viral parenchymal infections of the brain. Top Magn Reson Imaging 6:11–21

    PubMed  Google Scholar 

  36. Leonard JR, Moran CJ, Cross DT 3rd, Wippold FJ 2nd, Schlesinger Y, Storch GA (2000) MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings. AJR Am J Roentgenol 174:1651–1655

    PubMed  CAS  Google Scholar 

  37. Patel M (2007) Herpes simplex encephalitis. eMedicine, Radiology, Brain/spine. http://www.emedicine.com/radio/topic334.htm. Accessed 12 December 2007

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We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Children’s Hospital of Philadelphia, University of Pennsylvania, 34th and Civic Center Blvd., Philadelphia, PA, 119104, USA

    Arastoo Vossough, Robert A. Zimmerman, Larissa T. Bilaniuk & Erin M. Schwartz

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  1. Arastoo Vossough
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  2. Robert A. Zimmerman
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  3. Larissa T. Bilaniuk
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  4. Erin M. Schwartz
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Correspondence to Arastoo Vossough.

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Vossough, A., Zimmerman, R.A., Bilaniuk, L.T. et al. Imaging findings of neonatal herpes simplex virus type 2 encephalitis. Neuroradiology 50, 355–366 (2008). https://doi.org/10.1007/s00234-007-0349-3

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  • DOI: https://doi.org/10.1007/s00234-007-0349-3

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