Clinical Spectrum of the Herpes Simplex Encephalitis in Children: Clinical Features, Neuroimaging, Treatment, and Outcomes

Abstract

Abstract

Objective: Herpes simplex encephalitis is one of the most common causes of sporadic encephalitis in children and it is associated with high mortality and morbidity. This study aims at describing the clinical spectrum of herpes simplex encephalitis in children by identifying their neurological imaging features and assessing potential treatment outcomes.

Methods: Clinical, laboratory, and imaging findings in 14 patients with herpes simplex encephalitis were retrospectively reviewed during the period between January 2005 and January 2010 at Selcuk University, Department of Pediatric Neurology.

Results: Our study consisted of 14 patients including a patient who had a relapsing course. The median age of the patients was 3,6 years. Seizure and fever were the most common findings at admission. Cerebrospinal fluid glucose concentration was normal in all patients. Protein and red blood cell levels were elevated in 28% patients. Polymerase chain reaction testing for HSV was positive in 92% and cranial magnetic resonance imaging was suggestive of herpes simplex encaphalitis in all the patients. Prominent thalamic involvement was observed in patients less than 2 years of age, however cerebrospinal fluid findings in these patients were normal. 9 patients were left with no neurological sequelae however persistent neurological sequelae was present in 5 patients.

Conclusion: The findings suggested how challenging it could get to diagnose herpes encephalitis in children, especially those under the age of 2. Due to its diagnostic possibility in children presenting with convulsion and other encephalitic processes, treatment with acyclovir must be initiated as soon as herpes encephalitis is suspected to avoid further neurological insults.

Key Words: Herpes Encephalitis; Children; Acyclovir; Neuroimaging.

Keywords

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Journal of Turgut Ozal Medical Center

Öz

Amaç: Herpes simpleks ensefaliti çocuklarda sporadik ensefalitlerin en sık görülen nedenlerinden biridir ve yüksek morbidite ve mortalite oranına sahiptir. Bu çalışmada çocuklarda klinik ve nörogörüntüleme bulgularıyla tedavi sonuçlarının değerlendirilerek herpes simpleks ensefalitinin klinik spektrumunun belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Selçuk Üniversitesi, Çocuk Nöroloji kliniğinde 2005-2010 yılları arasında herpes simpleks ensefaliti tanısı ile izlenen 14 hastanın klinik, laboratuvar ve görüntüleme bulguları geriye yönelik olarak değerlendirildi. Bulgular: Serimiz rekürrens gösteren 1 olgu da dahil olmak üzere 14 hastadan oluşuyordu. Olgularımızın ortalama yaşı 3,6 yıl, en sık başvuru şikayetleri ise nöbet ve ateşti. Beyin omurilik sıvısı glukoz konsantrasyonu olguların tümünde normal bulunurken yüksek protein ve eritrosit değerleri olguların %28'inde tespit edildi. Herpes simpleks virüs polimeraz zincir reaksiyonu olguların %92’sinde pozitifti ve kraniyal manyetik rezonans görüntüleme bulguları olguların tümünde herpes simpleks ensefalitini düşündürmekteydi. 2 yaş altındaki çocuklarda beyin omurilik sıvısı bulguları normal olmasına rağmen talamik tutulum ön plandaydı. 9 olgu sekelsiz iyileşirken 5 olguda kalıcı nörolojik sekel gelişti. Sonuç: Bu bulgular çocuklarda özellikle de 2 yaşın altındaki çocuklarda herpes simpleks ensefaliti tanısının zor olduğunu göstermektedir. Konvulziyon ya da diğer ensefalit bulgularıyla başvuran çocuklarda olası tanılar içerisinde herpes simpleks ensefaliti mutlaka düşünülmeli ve kalıcı nörolojik sekelleri önlemek için asiklovir en erken dönemde başlanmalıdır

Anahtar Kelimeler

• Herpes Ensefaliti, Çocuk, Asiklovir, Nörogörüntüleme

Kaynakça

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