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August 6, 1982

Diagnosis of Herpes Simplex Encephalitis

Author Affiliations

Boston University School of Medicine Boston

JAMA. 1982;248(5):547. doi:10.1001/jama.1982.03330050031018

To the Editor.—  In their article "Herpes Simplex Encephalitis: Clinical Assessment" (1982;247:317), Whitley et al point out that the diagnosis of herpes simplex encephalitis can be made on clinical grounds, using various statistical approaches to available data, in about 75% of cases. They argue that this level of diagnostic accuracy is too low to justify treatment without definitive brain biopsy.This analysis fails to take into account the following three factors: (1) that despite a recent report,1 the incidence of vidarabine toxicity is low,2 (2) that there is mounting evidence that brain biopsy may yield false-negative results (or the results may come too late to affect clinical decision making),3 and (3) that all of the alternative diagnoses found in patients with negative brain biopsy results in their series should have been made by other means (eg, serological tests for cryptococcal meningitis, biochemical screening for metabolic abnormalities), without