HSV CNS infection: clinical features, neuroimaging and long-term outcome
| Patient (n/sex/age) | Fever (°C) | Encephalopathy | Convulsions (duration) | Lesions on CT | Lesions on MRI | Outcome (time after discharge*) |
|---|---|---|---|---|---|---|
| 1/F/3 months | Yes (39.2) | 2–23 h | Whole body (>30 min) | Haemorrhagic R and L hemispheres, oedema | ND | Developmental delay (cognitive and motor), spastic quadriplegia, blind, whole body convulsions (2 years) |
| 2/F/4 months | Yes† (NK) | ≥24 h | Partial, L hemiclonic (>30 min) | Haemorrhagic R and L temporal and parietal | ND | Developmental delay (cognitive), behavioural problems (4 years) |
| 3/M/5 months | Yes (38.2) | ≥24 h | Partial (<15 min) | Haemorrhagic R and L parietal, low density R and L temporal and R parieto-occipital | ND | Developmental delay (cognitive and motor), hypotonia, L homonymous hemianopia (10 months) |
| 4/M/6 months | Yes (38.2) | ≥24 h | Partial (>30 min) and L hemiplegia ≥24 h | Low density bifrontal | ND | Developmental delay (cognitive and motor), L hemiplegia, whole body convulsions (3 years) |
| 5/M/6 months | Yes (38) | ≥24 h | Partial L-sided (>30 min) and L hemiplegia ≥24 h | Haemorrhagic, low density L frontal, temporal and parietal | R cerebral hemisphere | Developmental delay (cognitive and motor), L hemiplegia and convulsions (2 years) |
| 6/F/6 months | Yes (38.8) | ≥24 h | Partial motor (>30 min) and L hemiplegia ≥24 h | R parietal, occipital | ND | Developmental delay (cognitive and motor), L homonymous hemianopia (1.5 years) |
| 7/F/6 months | Yes (38) | 2–23 h | Whole body (>30 min) | Low density frontal, temporal, parietal | R and L frontal and temporal, R parietal oedema and haemorrhage | Developmental delay (cognitive and motor), quadriparesis, convulsions, atonic attacks (2.5 years) |
| 8/M/8 months | Yes (38.5) | ≥24 h | Partial, R-sided with oculogyric crisis (>30 min) | Low density temporal lobe | ND | Recovered (1 year) |
| 9/F/10 months | Yes (NK) | ≥24 h | Whole body (15–30 min) | Low density R temporal and parietal | R temporal – no normal parenchyma | Developmental delay (cognitive and motor), autism, convulsions (4 years) |
| 10/F/10 months | Yes (38.5) | ≥24 h | Whole body (<15 min) | Low density R and L temporal lobe, serpiginous enhancement R sylvian fissure | ND | Developmental delay (cognitive) (1 year) |
| 11/F/10 months | Yes (39) | ≥24 h | Partial (>30 min) | Low density L temporal lobe | R temporal haemorrhagic and L temporal, parietal and occipital | Developmental delay (cognitive and motor), R hemiplegia, R homonymous hemianopia, convulsions (2 years) |
| 12/F/11 months | Yes (39.5) | <2 h | Partial (15–30 min) and Todd's paresis‡ | Low density L temporal | ND | Recovered (2 years) |
| 13/F/11 months | Yes (38.6) | 2–23 h | Partial, R-sided (>30 min) and Todd's paresis | Haemorrhagic R parietal lobe | R and L haemorrhagic parietal and parasagittal | Needs speech therapy (2 years) |
| 14/F/14 months | Yes (37.8) | ≥24 h | Partial, clonic R arm (15–30 min) | Normal | ND | Recovered (NK) |
| 15/F/17 months | No | NK§ | Whole body (>30 min) | Normal | ND | Convulsions, absences but attends normal school (2.5 years) |
| 16/F/17 months | Yes (39.2) | <2 h | Whole body (>30 min) | Normal | ND | Recovered (1 year) |
| 17/F/18 months | Yes (39.0) | 2–23 h | Whole body (<15 min) and ataxia ≥24 h | Normal | Diffuse high signal in white matter around ventricles | Hemiparesis (2.5 years) |
| 18/M/26 months | Yes (37.5) | ≥24 h | Partial (>30 min), ataxia ≥24 h | Normal | ND | Developmental delay (motor and cognitive) (4 years) |
| 19/M/35 months | Yes (38.5) | 2–23 h | Partial and whole body (15–30 min) and ataxia ≥24 h | Normal | Normal | Recovered (3.5 years) |
↵* Depended on date child last seen and date of return of the questionnaire.
↵† Preceding admission.
↵‡ Hemiplegia for <24 h.
↵§ Ictal, given thiopentone and transferred to paediatric intensive care unit at another hospital. Patient described as encephalopathic but duration not given – not possible to differentiate drug-induced from virus-induced encephalopathy.
CNS, central nervous system; HSV, herpes simplex virus; ND, not done; NK, not known.