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We performed a retrospective review of adult cases of HSV encephalitis from the ENCEPH-UK retrospective cohort study.

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In this preliminary study we sought to quantitatively examine serial MRI scans of people who have had HSV encephalitis to investigate changes in acute brain swelling over time, and potential resolution of swelling in response to corticosteroid therapy. Adjuvant corticosteroid therapy with aciclovir, in HSV encephalitis, was associated with improved clinical outcome at three months in a retrospective cohort study and a reduction in severity of MRI abnormalities MRI in a mouse model. Corticosteroids are used to treat other neurological infections, including meningitis due to pneumococcus or tuberculosis. ДЄciclovir stops viral replication but there is growing evidence that ongoing acute brain inflammation and swelling are major contributing factors to the pathogenesis of HSV encephalitis and may be related to poor outcome. However, survivors are left with a variety of sequelae including personality and behavioural changes, seizures, dysphasia and neuropsychological sequelae including memory problems. Treatment with aciclovir has been reported to improve mortality from 70% to approximately 10вЂ“20%. HSV encephalitis is currently treated with the antiviral drug aciclovir. Although a rare disease with incidence rates of 1 per 250вЂ“500,000, the impact of HSV is disproportionately large with huge socioeconomic demands on patients, their carers and the health services.

These changes are best visualized by use of Magnetic Resonance Imaging (MRI). It leads to haemorrhage, necrosis and extensive oedema, characteristically of the medial temporal lobes, and also additionally extends to affect other limbic areas including insular, cingulate and inferolateral frontal cortices. Herpes simplex virus (HSV) encephalitis is the most common infectious cause of sporadic encephalitis.

All other authors have no competing interests. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Д¬ompeting interests: Dr Simon S Keller is funded by a UK Medical Research Council grant, grant number MR/K023152/1 and Prof Tom Solomon is funded by the National Institute for Health Research by a Programme Grant for Applied Research with grant number RP-PG-108-10048. SSK is funded by a UK Medical Research Council grant (Grant Number MR/K023152/1). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Дata Availability: All relevant data are within the paper.ДЇunding: This article is independent research funded by the National Institute for Health Research Programme Grants for Applied Research Programme, (Understanding and improving the outcome of viral encephalitis, RP-PG-0108-10048). Received: OctoAccepted: JanuPublished: January 26, 2017Д¬opyright: В© 2017 Defres et al. Sawtell, Cincinnati Children's Hospital Medical Center, UNITED STATES (2017) A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology. Citation: Defres S, Keller SS, Das K, Vidyasagar R, Parkes LM, Burnside G, et al.

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