Herpes Simplex Virus Meningoencephalitis Masquerading as Acute Stroke With Broca's Aphasia: A Case Report

Abstract

This case report presents a rare and unique instance of a 70-year-old morbidly obese female with type 2 diabetes mellitus and bilateral lymphedema, who presented with fever and expressive aphasia, initially suspected to be a stroke. A negative CT scan prompted the performance of an MRI, which revealed suggestive imaging findings of herpes encephalitis. Following the MRI, the patient experienced seizures and required intubation in the intensive care unit. Subsequently, a lumbar puncture was performed, confirming the diagnosis of herpes simplex virus (HSV) meningoencephalitis. Prompt initiation of acyclovir therapy led to an improvement in aphasia, ultimately allowing for extubation and transfer to the general ward. The rarity of this case lies in the unusual manifestation of Broca's aphasia caused by HSV, which is not typically associated with this neurological deficit. This report highlights the importance of considering herpes encephalitis as a potential etiology in patients presenting with atypical neurological symptoms, even in the absence of typical radiological findings. Early diagnosis and appropriate management with acyclovir are crucial in improving outcomes in such cases.