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Images in Neurology
February 2007

Acute Retinal Necrosis Following Herpes Simplex Encephalitis

Arch Neurol. 2007;64(2):283. doi:10.1001/archneur.64.2.283

A 63-year-old man with a history of diabetes mellitus and angina had fever, pulsating headache, and vomiting 5 days before admission. On admission, he was not alert and was disoriented. Neurological examinations showed Wernicke aphasia, memory disturbance, dyscalculia, and construction apraxia. The cerebrospinal fluid had an increased number of lymphocytes (117/μL) and elevated protein levels (113 mg/dL), and polymerase chain reaction results were positive for herpes simplex virus. Fluid-attenuated inversion recovery magnetic resonance imaging revealed hyperintense signals in the temporal lobe and insular cortex of the left hemisphere as well as small lesions in the right subcortical area (Figure 1).