Herpes Simplex Encephalitis

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Abstract
Twenty cases clinically suggesting a viral encephalitis including fever and increased amount of protein and a monocytic pleocytosis of the spinal fluid are reported. The cases were equally divided between males and females. Only two cases were under 20 years of age; half were over the age of 50 years. Three cases occurred in the five month period of February through June; the rest occurred during mid-summer through the early winter months. The disease is essentially an all-season encephalitis affecting all ages. The herpes simplex virus was isolated from six fatal cases; in three, type A intranuclear inclusions were found in the brain; in two, a fourfold rise in complement-fix ing and/or neutralizing antibodies was obtained. In four more cases, type A intranuclear inclusions were observed in biopsies or tissue obtained at autopsy; virus was not isolated. However, in two of these four cases, a fourfold rise in specific antibodies was demonstrated. In a third group of 10 cases, the diagnosis rested on a clinical picture of viral encephalitis in which there was a four fold rise in herpes antibodies. None gave a previous history of herpes labialis or vaginalis. When the encephalitis progressed to coma and convulsions, as it did in 13 cases, 10 patients died and three recovered. All fatal cases died within 14 days of onset of signs and symptoms. This series emphasizes the hemorrhagic lesions that characterize herpetic encephalitis and the reflection of this lesion in the spinal fluid by the presence of otherwise unexplained erythrocytes in the spinal fluid a consistent finding in 10 cases personally observed.