Presentation
Full term infant presents with seizures and associated fever.
Patient Data
MRI of the brain demonstrates extensive hyperintensity on T2/FLAIR involving all lobes as well as the basal ganglia and thalami. There is associated diffusion restriction within the affected areas and mild diffuse cortical atrophy. There is cortical/subcortical hyperintensity on T1 and T2WI, consistent with laminar necrosis. On post-contrast imaging, there is leptomeningeal enhancement and likely cortical enhancement although assessment is limited due to intrinsic hyperintensity on T1WI. There is also a large subgaleal collection.
Case Discussion
This case demonstrates the typical features seen in subacute neonatal herpes simplex encephalitis with resulting atrophy and laminar necrosis. The serum was positive for PCR detected HSV-2 although CSF cultures were unable to be obtained following multiple failed attempts at LP.
Co-Author: Daniel P. Gewolb, M.D.
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