A case of HSV encaphelitis presenting as headache and amnesi
A 73-year-old woman presented with a severe headache, confusion, and primarily anterograde amnesia. She was febrile and had no focal neurologic deficits. Her lumbar puncture revealed elevated protein level, hypoglycorrhachia, and a lymphocytic pleocytosis.

MRI brain revealed a left-predominant region of hyperintensity on the fluid-attenuated inversion recovery sequence in the anterior medial temporal lobe including the hippocampus and surrounding structures.

The patient was diagnosed with herpes simplex encephalitis. Intravenous acyclovir was started empirically in this patient. Results of Gram’s staining and cultures of the cerebrospinal fluid were negative. Polymerase chain reaction of the cerebrospinal fluid revealed herpes simplex virus–1 DNA.

After treatment, the patient recovered, aside from residual short-term memory deficits.

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