June 1990

Long-term Cognitive Sequelae of Acyclovir-Treated Herpes Simplex Encephalitis

Author Affiliations

From the Division of Cognitive Neurology (Drs Gordon, Selnes, and Hart), the Department of Neurology (Drs Gordon, Selnes, Hart, and Hanley), and the Department of Anesthesiology (Dr Hanley), The Johns Hopkins University, Baltimore, Md, and the Department of Pediatrics, University of Alabama at Birmingham (Dr Whitley).

Arch Neurol. 1990;47(6):646-647. doi:10.1001/archneur.1990.00530060054017

• Survival from untreated herpes simplex type 1 encephalitis is well known to be accompanied by severe cognitive impairments. Recently, acyclovir has been proven to be the most effective available treatment for this disease, with the expectation that it would appreciably reduce morbidity. We performed detailed assessments of four consecutive patients who received acyclovir in the early stages of biopsy-proven herpes encephalitis and who now have been followed up for 1.5 to 4 years. All four patients showed definite residual on either clinical or formal neuropsychological testing, most commonly dysnomia and impaired new learning for both verbal and visual material, even though three had normal performance on a standard clinical mental status test. All four patients were unable to function at their prior level of achievement. Therefore, despite early administration of acyclovir in herpes encephalitis, long-lasting neuropsychological residua are likely. Furthermore, cognitive deficits of prognostic importance may not be detected by clinical screening.