Involvement of the white matter in the initial stage of herpes simplex encephalitis

Chronic Active Herpes Simplex Type 2 Encephalitis in an Asymptomatic Immunocompetent Child

“…Mitsufuji and Ikuta 19 compared the white matter lesions of their case with those of 4 similar cases [20][21][22] and classified them into 2 types: lesions with delayed perivascular focal myelin destruction in patients with subacute evolution 21 and widespread lesions with no relation to gray matter lesions seen in the acute stage. [20][21][22] The latter lesions were noted to disappear spontaneously from 7 weeks 20 to 2 years 19 of onset without treatment or clinical findings.…”

“…Mitsufuji and Ikuta 19 compared the white matter lesions of their case with those of 4 similar cases [20][21][22] and classified them into 2 types: lesions with delayed perivascular focal myelin destruction in patients with subacute evolution 21 and widespread lesions with no relation to gray matter lesions seen in the acute stage. [20][21][22] The latter lesions were noted to disappear spontaneously from 7 weeks 20 to 2 years 19 of onset without treatment or clinical findings. Histologic findings, when herpes simplex encephalitis recurs months to years after infection, show perivascular clusters of lymphocytes and macrophages, nonnecrotic granulomas, granulomatous giant cells without necrosis, multinucleated giant cells, and calcifications, 1 while chronic granulomatous inflammation with foci of calcification has been described years after the first episode of herpes simplex encephalitis.…”

Acquired white matter injury: Infection and inflammatory processes

“…One of the most common sites for CNS damage in pediatric HSV infections appears to be in the subcortical WM of the temporal and parietal lobes. Several case reports demonstrate FLAIR and T2-weighted signal hyperintensities in temporal WM, particularly in the right lobe [44][45][46]. T2-weighted hyperintensities have also been observed in the corpus callosum, parietal WM, periventricular WM, and subcortical WM [46][47][48].…”