Herpes simplex encephalitis in an immunocompromised adult with novel MRI and pathology findings

Excerpt

Punctate scattered hyperintense diffusion-weighted imaging (DWI) lesions in convexities of both hemispheres have not been described in children or adult patients with herpes simplex encephalitis (HSE). Because this finding suggests a hematogenous spread of herpes infections, it has a special clinical significance. We present a case of HSE in an immunocompromised adult where multiple small DWI hyperintense lesions were seen at the grey-white matter junction of both cerebral hemispheres. A follow-up magnetic resonance imaging (MRI) 3 weeks later showed typical herpetic involvement of the limbic system. Autopsy revealed that the multiple small MRI abnormalities represented punched out pauci-inflammatory areas of parenchymal necrosis. …