ArticleInfection2019
Challenges in HSV encephalitis: normocellular CSF, unremarkable CCT, and atypical MRI findings.
Article in Infection, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Unveiling the clinical spectrum of herpes simplex virus CNS infections in adults: a systematic review.Systematic reviews · 2025Pooled it
- A Fatal Herpes Simplex Encephalitis with a Normocellular Cerebrospinal Fluid: A Case Report.Journal of clinical medicine · 2026Article
- Aspiration Pneumonia with Herpes Simplex Encephalitis in an Elderly Japanese Patient.Internal medicine (Tokyo, Japan) · 2026Article
- Atypical Presentations at Risk for Diagnostic Errors in Internal Medicine: A Scoping Review.Journal of general internal medicine · 2026Article
- Study on the final diagnosis of nervous system diseases with psychiatric symptoms as manifestation onset.BMC psychiatry · 2025Article
- [Management of acute community-acquired bacterial meningitis : Leading symptoms of impaired consciousness and fever with/without headache].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Review
- Clinical application of metagenomic next-generation sequencing in rapid diagnosis and prognostic assessment of herpes simplex encephalitis.Frontiers in microbiology · 2025Article
- A Case of HSV Encephalitis Misdiagnosed as Worsening Psychiatric Condition: A Case Report.International medical case reports journal · 2025Article
- From a focal skin issue to a systemic disease: the multifaceted nature of cold sores, novel findings.Virusdisease · 2024Article
- Elsberg Syndrome With Albuminocytologic Dissociation - A Guillain-Barré Syndrome Mimic or Guillain-Barré Syndrome Variant?The Neurohospitalist · 2024Article
- The immunobiology of herpes simplex virus encephalitis and post-viral autoimmunity.Brain : a journal of neurology · 2024Review
- Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review.Frontiers in neurology · 2023Review
- Analysis of Metagenomic Next-Generation Sequencing (mNGS) in the Diagnosis of Herpes Simplex Virus (HSV) Encephalitis with Normal Cerebrospinal Fluid (CSF).Infection and drug resistance · 2023Article
- Neurology of Acute Viral Infections.The Neurohospitalist · 2022Review
- Herpes Simplex Virus Meningoencephalitis Following Pulse-Dose Methylprednisolone: A Case Report and Literature Review.The American journal of case reports · 2021Review
- Microbiological Outcomes Associated With Low Leukocyte Counts in Cerebrospinal Fluid.Open forum infectious diseases · 2021Article
- Case Report: HSV-2 Encephalitis Presenting With Chorea; Effects of Infection Alone or Combination of Infection and Autoimmunity?Frontiers in neurology · 2021Article
- Article
- Third time's a charm: diagnosis of herpes simplex encephalitis after two negative polymerase chain reaction results.Heliyon · 2020Article
- Travel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy - a case report.BMC infectious diseases · 2020Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeHerpes simplex virus (HSV) encephalitis continues to be the most common form of sporadic lethal encephalitis worldwide. The wide spectrum of clinical presentations and laboratory findings often poses a diagnostic challenge for physicians which might delay administration of life-saving therapy with acyclovir. Atypical presentations of HSV encephalitis have become increasingly prevalent with better diagnostic techniques and have not been well studied.
methodsWe retrospectively evaluated all consecutive PCR-proven HSV encephalitis cases treated at the Hospital of the Ludwig-Maximilians-University in Munich, Germany from January 1, 2013 to February 28, 2018.
resultsWe included 18 patients with PCR-proven HSV encephalitis. The most common clinical features were altered mental status (77.8%), focal neurologic deficits (72.2%) and fever (72.2%). Remarkably, four of these patients (22.2%) had a normocellular cerebrospinal fluid (CSF) on admission. Electroencephalography and magnetic resonance imaging abnormalities were highly sensitive for HSV encephalitis independent of CSF cell count. Striking atypical findings on MRI were extensive global brain swelling and severe brainstem involvement in single patients. Of note, initial CT scans were normal in 11 out of 16 patients (68.8%). All patients were treated with acyclovir. Three patients still developed a clinical deterioration under therapy with acyclovir with one patient requiring decompressive craniotomy due to bilateral space-occupying temporal lobe hemorrhage. 94.4% of the patients survived but only 38.9% were discharged with a good clinical outcome (Glasgow Outcome Score = 5).
conclusionAtypical presentations of HSV encephalitis seem to be more common than previously thought and physicians should apply a high level of clinical suspicion and a low threshold to initiate life-saving acyclovir therapy in suspected cases.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.