Encephalitis Associated with Herpes Simplex Virus

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Abstract
Five cases of encephalitis in which herpes simplex virus was isolated had clinical features similar to those seen in other kinds of encephalitis (fever, headache, nuchal rigidity, delirium and coma). The occurrence of focal seizures, fixed conjugate eye deviation, aphasia, hemiparesis, uncinate fits, and hallucinations suggested focal involvement of the cerebral hemisphere, which, in association with evident infection in the central nervous system, raised the possibility of cerebral abscess. In the four cases in which they were recorded, the electroencephalograms were markedly abnormal. Widespread arrhythmic slow activity was seen in all, and in three there was unilateral or regional predominance. In addition, three contained localized sharp waves or spike and wave complexes which occasionally developed into focal electrographic seizure discharges. Viruses were isolated from the cerebrum and pharyngeal secretions but not from the brain stem, spinal cord, spinal fluid, or other body organs. Evidence is presented which suggests that herpes simplex encephalitis in adults may be a localized recurrent manifestation of a latent herpes simplex infection.