Table 2

HSV CNS infection: clinical features, neuroimaging and long-term outcome

Patient (n/sex/age)Fever (°C)EncephalopathyConvulsions (duration)Lesions on CTLesions on MRIOutcome (time after discharge*)
1/F/3 monthsYes (39.2)2–23 hWhole body (>30 min)Haemorrhagic R and L
hemispheres, oedema
NDDevelopmental delay (cognitive
and motor), spastic quadriplegia,
blind, whole body convulsions
(2 years)
2/F/4 monthsYes (NK)≥24 hPartial, L hemiclonic
(>30 min)
Haemorrhagic R and L
temporal and parietal
NDDevelopmental delay (cognitive),
behavioural problems (4 years)
3/M/5 monthsYes (38.2)≥24 hPartial (<15 min)Haemorrhagic R and L
parietal, low density R
and L temporal and R
NDDevelopmental delay (cognitive
and motor), hypotonia, L homonymous
hemianopia (10 months)
4/M/6 monthsYes (38.2)≥24 hPartial (>30 min) and
L hemiplegia ≥24 h
Low density bifrontalNDDevelopmental delay (cognitive
and motor), L hemiplegia, whole
body convulsions (3 years)
5/M/6 monthsYes (38)≥24 hPartial L-sided
(>30 min) and L
hemiplegia ≥24 h
Haemorrhagic, low density
L frontal, temporal
and parietal
R cerebral
Developmental delay (cognitive
and motor), L hemiplegia and convulsions
(2 years)
6/F/6 monthsYes (38.8)≥24 hPartial motor
(>30 min) and
L hemiplegia ≥24 h
R parietal, occipitalNDDevelopmental delay (cognitive
and motor), L homonymous hemianopia
(1.5 years)
7/F/6 monthsYes (38)2–23 hWhole 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 monthsYes (38.5)≥24 hPartial, R-sided
with oculogyric crisis
(>30 min)
Low density temporal
NDRecovered (1 year)
9/F/10 monthsYes (NK)≥24 hWhole body
(15–30 min)
Low density R temporal
and parietal
R temporal
– no normal
Developmental delay (cognitive
and motor), autism, convulsions
(4 years)
10/F/10 monthsYes (38.5)≥24 hWhole body (<15 min)Low density R and
L temporal lobe, serpiginous
R sylvian fissure
NDDevelopmental delay (cognitive)
(1 year)
11/F/10 monthsYes (39)≥24 hPartial (>30 min)Low density L temporal
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 monthsYes (39.5)<2 hPartial (15–30 min)
and Todd's paresis
Low density L
NDRecovered (2 years)
13/F/11 monthsYes (38.6)2–23 hPartial, R-sided
(>30 min) and Todd's paresis
Haemorrhagic R
parietal lobe
R and L haemorrhagic
parietal and
Needs speech therapy (2 years)
14/F/14 monthsYes (37.8)≥24 hPartial, clonic R arm
(15–30 min)
NormalNDRecovered (NK)
15/F/17 monthsNoNK§Whole body (>30 min)NormalNDConvulsions, absences but attends
normal school (2.5 years)
16/F/17 monthsYes (39.2)<2 hWhole body (>30 min)NormalNDRecovered (1 year)
17/F/18 monthsYes (39.0)2–23 hWhole body (<15 min) and
ataxia ≥24 h
NormalDiffuse high signal
in white matter
around ventricles
Hemiparesis (2.5 years)
18/M/26 monthsYes (37.5)≥24 hPartial (>30 min),
ataxia ≥24 h
NormalNDDevelopmental delay (motor and
cognitive) (4 years)
19/M/35 monthsYes (38.5)2–23 hPartial and whole body
(15–30 min) and ataxia
≥24 h
NormalNormalRecovered (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.