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December 1987

Yes, Brain Biopsy Should Be a Prerequisite for Herpes Simplex Encephalitis Treatment

Author Affiliations

From the Departments of Neurology, Neurosurgery, and Anesthesia Critical-Care Medicine, The Johns Hopkins Hospital, Baltimore (Drs Hanley and Johnson), and the Departments of Pediatrics and Microbiology, University of Alabama at Birmingham (Dr Whitley).

Arch Neurol. 1987;44(12):1289-1290. doi:10.1001/archneur.1987.00520240061013

Herpes simplex encephalitis (HSE) is one of many types of viral encephalitis. Epidemiologic estimates of incidence range from 1000 to 2000 cases per year in the United States. This accounts for only 5% to 10% of the 20 000 reported cases of encephalitis that occur yearly. The usual clinical presentation of encephalitis is an acute febrile illness with altered behavior, decreased level of consciousness, and focal neurologic deficits. Herpes simplex encephalitis is distinguished from other causal agents by being the most common cause of sporadic fatal encephalitis in the United States with a 70% mortality rate in untreated patients. Clinically, HSE commonly shows early focal neurologic deficits on physical examination and by computed tomography, electroencephalogram, or brain scan.1 Unfortunately, many other viral illnesses, bacterial infections, and any acute mass lesion can present with a focal basal temporal localization that mimics HSE.1-3 Studies using vidarabine and, subsequently, acyclovir

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