Herpes Simplex Encephalitis

Abstract

A presumptive diagnosis of herpes simplex encephalitis was made in five patients with distinctive clinical findings and compatible cerebrospinal fluid abnormalities. The diagnosis was confirmed by cerebral biopsy and recovery of herpes simplex virus within 2 to 21 days from each biopsy. One patient died nine days after admission to the hospital, and another, treated five days with idoxuridine, died 77 days later without significant clinical improvement. The third patient survived but with severe permanent dementia and focal neurologic signs. Two other patients survived and have no neurologic sequelae. Marked improvement was noted in the last two patients following therapy with adrenal corticosteroids. The disease course in these patients suggests caution in evaluating the role of idoxuridine therapy in this infection.