Predictors of outcome in HSV encephalitis

Tarun D. Singh, Jennifer E. Fugate, Sara Hocker, Eelco F M Wijdicks, Allen Jr. Aksamit, Alejandro Rabinstein

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

This study aims to explore the clinical features, radiological findings, management and the factors influencing prognosis in PCR-confirmed herpes simplex virus encephalitis (HSE). This is a retrospective review of consecutive patients diagnosed with HSE at Mayo Clinic, Rochester, MN, between January 1995 and December 2013. Only HSE cases confirmed by PCR were included. Univariate and multivariate analysis was used to identify factors associated with good (modified Rankin Scale of 0–2) or poor outcome (mRS of 3–6) at hospital discharge and 1-year follow-up. We identified 45 patients with HSE. Median age was 66 (IQR 53.5–78) years. HSE was caused by HSV-1 in 33 cases and by HSV-2 in 9. Nearly half had seizures upon admission or during hospitalization. The most common regions involved on MRI were the temporal lobe in 35 (87.5 %), insula in 28 (70.0 %), frontal lobe in 27 (67.5 %) and thalamus in 11 (27.5 %) patients. MRI pattern was quite homogeneous with HSV-1 infection, but much more heterogeneous with HSV-2. Good outcome at discharge and at 6–12 months was seen in 16 (35.6 %) and 27 (65.9 %) patients, respectively. On multivariate analyses, older age (p = 0.001), coma (p = 0.008), restricted diffusion on MRI (p = 0.005) and acyclovir started after the first day of admission (p = 0.050) were associated with poor outcome at discharge. Older age, development of coma, presence of restricted diffusion on brain MRI and delay in the administration of acyclovir portend poor outcome in HSE. Conversely, presence of seizures, focal neurological deficits, EEG abnormalities and location or extension of FLAIR/T2 abnormalities did not influence functional outcome.

Original languageEnglish (US)
Pages (from-to)277-289
Number of pages13
JournalJournal of Neurology
Volume263
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Herpes Simplex Encephalitis
Encephalitis
Simplexvirus
Human Herpesvirus 2
Acyclovir
Human Herpesvirus 1
Coma
Seizures
Multivariate Analysis
Polymerase Chain Reaction
Diffusion Magnetic Resonance Imaging
Frontal Lobe
Temporal Lobe
Thalamus
Electroencephalography
Hospitalization
Brain
Infection

Keywords

  • DWI
  • Encephalitis
  • Herpes simplex virus
  • Imaging
  • Outcome
  • Viral infections

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Predictors of outcome in HSV encephalitis. / Singh, Tarun D.; Fugate, Jennifer E.; Hocker, Sara; Wijdicks, Eelco F M; Aksamit, Allen Jr.; Rabinstein, Alejandro.

In: Journal of Neurology, Vol. 263, No. 2, 01.02.2016, p. 277-289.

Research output: Contribution to journalArticle

Singh, TD, Fugate, JE, Hocker, S, Wijdicks, EFM, Aksamit, AJ & Rabinstein, A 2016, 'Predictors of outcome in HSV encephalitis', Journal of Neurology, vol. 263, no. 2, pp. 277-289. https://doi.org/10.1007/s00415-015-7960-8
Singh, Tarun D. ; Fugate, Jennifer E. ; Hocker, Sara ; Wijdicks, Eelco F M ; Aksamit, Allen Jr. ; Rabinstein, Alejandro. / Predictors of outcome in HSV encephalitis. In: Journal of Neurology. 2016 ; Vol. 263, No. 2. pp. 277-289.
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