A case study discusses a 40-year-old diabetic woman diagnosed with herpes simplex type 1 encephalitis, presenting with various symptoms including fever and confusion. Imaging revealed hypodensities in the left side of the brain, and CSF analysis showed elevated protein levels and positive PCR for HSV-1 DNA. The document also notes important diagnostic procedures and provides links to further resources and publications by the author.

1. Short case publication... Version 3.11 | Edited by professor Yasser Metwally | January 2010
Short case
Edited by
Professor Yasser Metwally
Professor of neurology
Ain Shams university school of medicine
Cairo, Egypt
Visit my web site at:
http://yassermetwally.com
A 40 years old diabetic woman presented clinically with Symptoms and signs of encephalitis can include fever, headache,
lethargy, irritability, confusion, focal deficit, seizures and meningeal irritations signs.
DIAGNOSIS: HERPES SIMPLEX TYPE 1 ENCEPHALITIS

2. Figure 1. (A,B,C) A case of herpes encephalitis, precontrast CT scan. Notice the bitemporal, hypodensity, more in the left side.
Also notice insular, cingulate, and posterior orbital frontal hypodensities, more on the left side. A haemorrhagic component is
noticed at the left temporal lobe. The CT hypodensity represent vasogenic edema secondary to the associated vasculopathy.
Figure 2. (A,B,C) Herpes encephalitis, precontrast CT scan. Notice the insular, cingulate, and posterior orbital
frontal hypodensities, more on the left side. The CT hypodensity represent vasogenic edema secondary to the
associated vasculopathy. Mild mass effect is noticed on the left side.

3. CSF examination
The opening pressure was elevated, and a CSF pleocytosis was observed. The patients had a mononuclear
pleocytosis,(200 cells/mm3 (0.2 × 109 cells/l). CSF protein levels was elevated and the CSF glucose level was normal.
Polymerase chain reaction (PCR) was positive for HSV-1 DNA . Detection of HSV-1 DNA in CSF is sensitive and
specific, and has become the diagnostic procedure of choice.
Electroencephalography
Electroencephalography showed background disorganization with generalized and focal slowing, predominantly over the
involved left temporal region. Widespread, periodic and stereotyped sharp-wave and slow-wave complexes develop at
intervals of 2–3 seconds was seen.
References
1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency for
electronic publishing, version 11.1a December 2010
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