Herpes simpleks ensefaliti BT bulguları

Özet

Herpes simpleks ensefaliti, akut bilinç değişikliği, ateş veya nöbetle başvurabilen ve özellikle temporal-limbik sistemi tutan zaman kritik bir enfeksiyondur. Kontrastsız BT temporal lobdaki hemorajik değişikliği gösterebilir; HSE tanısında beyin MR’ı BT’den daha duyarlı ve özgül görüntüleme yöntemidir. Görüntülemede temporal ve insular tutulum ile ödem saptanır; ilerleyen olgularda hemoraji izlenebilir ve MR tanıda tercih edilir. Normal BT'yi dışlayıcı kabul etmek veya limbik dağılımı tanımamak tanı değerlendirmesinde tehlikeli gecikmeye neden olabilir.

Faz ve pencere

Kontrastsız tanısal: İlk BT normal olabilir; HSE’de kontrastsız BT temporal lobda hemorajik dönüşüm gösterebilir. MR (T2/FLAIR ve difüzyon) tanısal değerlendirmede daha duyarlıdır.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

BeyinG 80 / M +40
İnmeG 40 / M +40

BT bulguları

HSE’de temporal lob, insula ve hipokampusta şişme ve T2 sinyal artışı görülebilir.
İnsular tutulum — temporal lob lezyonuyla birlikte insulada da ödem ve sinyal değişikliği izlenir.
HSE’de MR’da temporal lobda T2 sinyal artışı ve difüzyon kısıtlaması görülebilir; kontrastsız BT’de hemorajik dönüşüm saptanabilir.
Kitle etkisi — şiddetli ödem veya hemoraji sonucu orta hatta kayma ve herniasyon riski izlenebilir.
Damar alanını aşan yayılım — medial temporal ve insular tutulum tek bir MCA dal alanına sınırlı kalmayabilir.
Temporal lob tutulumunda hemorajik değişiklikler ve nekroz görülebilir; peteşiyal kortikal kanamalar yaygın, frank hematom ise nadirdir.
Erken normal görünüm — özellikle başlangıç döneminde kontrastsız BT'de belirgin parankim değişikliği olmayabilir.
HSE’de temporal lob, insula ve hipokampus tutulabilir; orbitofrontal tutulum da bildirilmiştir.

Normalde

Karşılaştırma — lezyonun asimetrisi, sinyal yoğunluğundaki artış ve anatomik dağılımın tipik olmaması dikkat çekicidir. Değerlendirme — temporal ve insular bölgede beklenmeyen asimetri, ödem ve sinyal değişikliği ayırıcı tanı açısından önemlidir.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0103; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Orta serebral arter infarktı: kortikal-subkortikal hipodansite damar alanına uyar; HSV lezyonu limbik yapıları tutup arter sınırlarını aşabilir.
Otoimmün limbik ensefalit: mezial temporal T2/FLAIR hiperintensitesi HSV ensefalitine özgü değildir; otoimmün ensefalit de bu bulgunun ayırıcı tanısında yer alır.
Nöbet sonrası değişimler: hipokampus, pulvinar ve kortekste ödem ve sinyal değişikliği yapabilir; geri dönücüdür.
Gliom/Astrocytoma: herpetik meningoensefalit taklidi yapabilir; biyopsi ve ileri görüntüleme gerekebilir.
Serebral apse: merkezinde düşük atenüasyon ve çevresel ödem bulunabilir; halka biçimli kontrastlanma ve klinik enfeksiyon odağı ayırıcıdır.

Tuzaklar

Başlangıç BT'sinin doğal olması HSV ensefalitini elemez; BT görünür ödemi göstermediğinde bile klinik şüphe sürüyorsa ileri değerlendirme gerekir.
Temporal hipodansiteyi doğrudan infarkt saymayın; lezyonun insula ve hipokampusa uzanımını, damar alanı sınırlarını geçip geçmediğini inceleyin.
Hemoraji tespiti — şüpheli durumlarda GRE/SWI gibi hassas sekanslar veya seri BT faydalı olabilir.
Bazal ganglion korunması HSV için tek başına kanıt değildir; periiktal ve otoimmün limbik hastalık benzer temporal görünüm oluşturabilir.

Kendini dene

Ateş ve konfüzyonla başvuran hastada BT'de asimetrik medial temporal ve insular hipodansite, lokal sulkus basısı var. En olası tanı nedir?
Cevabı göster
HSV ensefaliti. Asimetrik limbik-temporal ve insular dağılım akut klinik bağlamda HSV ensefalitini destekler. İnfarkt genellikle arter alanına uyar; otoimmün ensefalit görüntüde benzer olabilir ama etken BT ile belirlenemez; gliom çoğunlukla daha yavaş gelişen kitle/infiltrasyon örüntüsü verir.
Ensefalopati ve nöbeti olan hastanın ilk kontrastsız BT'sinde belirgin anormallik yok. Bu bulgu nasıl yorumlanmalıdır?
Cevabı göster
Erken HSV dışlanmaz. Erken HSV ensefalitinde BT doğal görünebilir; normal sonuç hastalığı dışlamaz. Bu görünüm HSV'yi kesinleştirmez, infarkt lehine özgül değildir ve klinik ensefaliti dışlamaz.

İlgili konular

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 19 cümle bu karşılaştırmada düzeltildi (2026-10-09).

Herpes simplex encephalitis following ChAdOx1 nCoV-19 vaccination: a case report and review of the literaturepmc.ncbi.nlm.nih.gov
cGAS–STING axis: A central regulator of neural homeostasis and neuroinflammatory pathogenesispmc.ncbi.nlm.nih.gov
Decompressive craniectomy for herpes simplex encephalitis complicated by frank intracerebral hemorrhage: a case report and review of the literaturepmc.ncbi.nlm.nih.gov
Approach to recurrent Herpes Simplex Encephalitis in childrenpmc.ncbi.nlm.nih.gov
When herpes simplex virus encephalitis meets antiviral innate immunitypmc.ncbi.nlm.nih.gov
Infectious leukoencephalopathies.pubmed.ncbi.nlm.nih.gov
Steroids in neuroinfection.pubmed.ncbi.nlm.nih.gov
[Neuropathological findings of non-herpetic limbic encephalitis].pubmed.ncbi.nlm.nih.gov
[Recent progress in autoimmune encephalitis and its related disorders].pubmed.ncbi.nlm.nih.gov
T2/FLAIR Hyperintensity in Mesial Temporal Lobe: Challenging Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
The fornix in health and disease: an imaging review.pubmed.ncbi.nlm.nih.gov
A case of late herpes simplex encephalitis relapse.pubmed.ncbi.nlm.nih.gov
Herpes simplex virus encephalitis during treatment with etanercept.pubmed.ncbi.nlm.nih.gov
Herpes simplex encephalitis following spinal ependymoma resection: case report and literature review.pubmed.ncbi.nlm.nih.gov
Mesiotemporal changes on magnetic resonance imaging in neurosyphilis.pubmed.ncbi.nlm.nih.gov
Anti-metabotropic glutamate receptor 5 encephalitis: Five case reports and literature review.pubmed.ncbi.nlm.nih.gov
[Infection or Autoimmunity: Key Imaging Points for Differential Diagnosis].pubmed.ncbi.nlm.nih.gov
Decompressive craniectomy for herpes simplex encephalitis complicated by frank intracerebral hemorrhage: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
A Fatal Herpes Simplex Encephalitis with a Normocellular Cerebrospinal Fluid: A Case Report.pubmed.ncbi.nlm.nih.gov
Acute Expressive Aphasia and Confusion As the Initial Neurologic Manifestation of Herpes Simplex Virus Type 1 Encephalitis.pubmed.ncbi.nlm.nih.gov
Masked by Aneurysmal Hemorrhage: Herpes Simplex Virus (HSV)-2 Encephalitis in a Patient With Subarachnoid and Intraparenchymal Hemorrhage.pubmed.ncbi.nlm.nih.gov
Stepwise clinical and diagnostic strategy for coma of unknown origin.pubmed.ncbi.nlm.nih.gov
What every neuropathologist needs to know: Update on neuro infectious disease workups and consultation resources.pubmed.ncbi.nlm.nih.gov
Arterial Spin Labeling technique and clinical applications of the intracranial compartment in stroke and stroke mimics - A case-based review.pubmed.ncbi.nlm.nih.gov
A Diagnostic Challenge: From Suspected Ischemic Stroke to Confirmed Herpetic Encephalitis.pubmed.ncbi.nlm.nih.gov
Glioblastoma mimicking anti-NMDA receptor encephalitis: a case series.pubmed.ncbi.nlm.nih.gov
Biomarker-Based Diagnosis and Care Pathways for Alzheimer's Disease in the Era of Disease-Modifying Treatments: A Consensus Statement by Belgian Experts.pubmed.ncbi.nlm.nih.gov
Unraveling functional neurological disorder in pediatric populations: A systematic review of diagnosis, treatment, and outcomes.pubmed.ncbi.nlm.nih.gov
Effects of working memory and reward reactivity on externalizing behaviors in the ABCD study.pubmed.ncbi.nlm.nih.gov
Ear and Nose Abnormalities in Meningoencephalitis Associated With Relapsing Polychondritis: A Case Report.pubmed.ncbi.nlm.nih.gov
Antemortem radiologic and histopathologic presentation of Marchiafava-Bignami disease.pubmed.ncbi.nlm.nih.gov
Rapidly Progressive Dementia.pubmed.ncbi.nlm.nih.gov
Treatment of Herpes simplex encephalitis with the helicase-primase inhibitor pritelivir in an immunocompromised patient.pubmed.ncbi.nlm.nih.gov
Eastern Equine Encephalitis Virus Complex: Human Disease, Diagnosis and Treatment.pubmed.ncbi.nlm.nih.gov
Neuroimaging in inborn errors of immunity: More than infections.pubmed.ncbi.nlm.nih.gov
Herpes simplex virus infection of the central nervous system presenting as a stroke: Case report and review of the literature.pubmed.ncbi.nlm.nih.gov
Seronegative Autoimmune Encephalitis With Neuropsychiatric Presentation: A Case Report.pubmed.ncbi.nlm.nih.gov
Modality-Specific and Multimodal 'Associative' Forms of Face and Voice Recognition Disorders in Patients with Right Anterior Temporal Lesions: A Review of Single-Case Studies.pubmed.ncbi.nlm.nih.gov
Herpes simplex virus encephalitis following acute brain injury: illustrative cases.pubmed.ncbi.nlm.nih.gov
Treatment and Diagnostic Challenges in a Patient with Atypical SARS-CoV-2-Associated Encephalitis Mimicking a Neoplasm: A Case Report.pubmed.ncbi.nlm.nih.gov
Neonatal herpes simplex virus encephalitis: a single-center retrospective study of 14 cases.pubmed.ncbi.nlm.nih.gov
Ischemic Stroke in Hypereosinophilic Syndrome: A Clinicopathologic Study of Two Cases.pubmed.ncbi.nlm.nih.gov
Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications.pubmed.ncbi.nlm.nih.gov
Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis.pubmed.ncbi.nlm.nih.gov
Gyriform restricted diffusion in adults: looking beyond thrombo-occlusions.pubmed.ncbi.nlm.nih.gov
Magnetic resonance imaging of arterial stroke mimics: a pictorial review.pubmed.ncbi.nlm.nih.gov
Atypical manifestations of Dengue fever: case series in tertiary care hospital in Nepal.pubmed.ncbi.nlm.nih.gov
Acute necrotizing encephalopathy in a young adult triggered by adenovirus: a rare etiology of a devastating neurological syndrome.pubmed.ncbi.nlm.nih.gov
Rapidly Progressive Multiple Ischemic Lesions Caused by Cryptococcus neoformans Infection Presenting with Meningoencephalitis and Cerebral Infarction as the Initial Manifestations: A Case Report.pubmed.ncbi.nlm.nih.gov
Ophelia Syndrome: Acute Stupor as a Primary Manifestation of Hodgkin Lymphoma Diagnosed by Fluorodeoxyglucose Positron Emission Tomography.pubmed.ncbi.nlm.nih.gov
From a Pinched Nerve to a Fatal Prognosis: Sporadic Creutzfeldt-Jakob Disease Masquerading as Cervical Myelopathy.pubmed.ncbi.nlm.nih.gov
Management of severe acute encephalopathy in the ICU: an expert consensus statement from the french society of intensive care medicine.pubmed.ncbi.nlm.nih.gov
Suspected encephalitis in adults.pubmed.ncbi.nlm.nih.gov
Autoimmune encephalitis induced by atezolizumab and bevacizumab therapy for advanced hepatocellular carcinoma: a case report.pubmed.ncbi.nlm.nih.gov
Headache Attributed to Infection: A Clinical and Pathophysiological Overview.pubmed.ncbi.nlm.nih.gov
MOG-Ab-associated optic neuritis with concurrent GFAP-Ab positivity following tislelizumab-based treatment: a case report.pubmed.ncbi.nlm.nih.gov
Automatic segmentation and quantitative analysis of brain CT volume in 2-year-olds using deep learning model.pubmed.ncbi.nlm.nih.gov
Development and validation of multiple machine learning models for identifying factors associated with walking ability in ischemic stroke patients: a single-center retrospective study with SHAP approach.pubmed.ncbi.nlm.nih.gov
Wnt and Nodal asymmetries stratify mouse laterality phenotypes in the absence of node flow.pubmed.ncbi.nlm.nih.gov
Notch3 is an asymmetric gene and a modifier of heart looping defects in Nodal mouse mutants.pubmed.ncbi.nlm.nih.gov
Radiological assessment of dementia: the Italian inter-society consensus for a practical and clinically oriented guide to image acquisition, evaluation, and reporting.pubmed.ncbi.nlm.nih.gov
Acute ischemic stroke in a young adult in association with Epstein-Barr virus infection: a case report.pubmed.ncbi.nlm.nih.gov
Copine-5-IgG-related autoimmune encephalitis: a novel paraneoplastic neurological syndrome with a strong melanoma association.pubmed.ncbi.nlm.nih.gov
Neurological manifestations of Varicella zoster infection: A case series.pubmed.ncbi.nlm.nih.gov
Etiological spectrum, risk factors, and outcomes of pediatric acute encephalitis: a 17-year pediatric intensive care unit retrospective cohort study.pubmed.ncbi.nlm.nih.gov
Research progress on the association between Hashimoto's thyroiditis and autoimmune encephalitis: a review.pubmed.ncbi.nlm.nih.gov
Clinical Reasoning: A Teenager With Chronic Meningitis-Does Occam's Razor Apply?pubmed.ncbi.nlm.nih.gov
Encephalitis with Extensive Cortical Brain Magnetic Resonance Imaging Changes Secondary to Myelin Oligodendrocyte Glycoprotein Antibody Disease.pubmed.ncbi.nlm.nih.gov
Herpes simplex reactivation or postinfectious inflammatory response after epilepsy surgery: Case report and review of the literature.pubmed.ncbi.nlm.nih.gov
Autoimmune Encephalitis Masquerading As Acute Psychosis: A Cause of Delayed Treatment.pubmed.ncbi.nlm.nih.gov
Diagnostic challenges in an adult patient with Fanconi Anemia: Neuroinflammatory Syndrome (FANS) intertwined with infectious processes.pubmed.ncbi.nlm.nih.gov
The Case of a 40-Year-Old Man With New-Onset Status Epilepticus in the Setting of HIV Infection.pubmed.ncbi.nlm.nih.gov
Treatment of acute demyelinating encephalomyelitis associated with recent rickettsial infection.pubmed.ncbi.nlm.nih.gov
Scrub Typhus Meningoencephalitis With Concurrent Brucellosis in Rural Nepal: Diagnostic Challenges With Negative PCR in a Low-Resource Setting.pubmed.ncbi.nlm.nih.gov
Opportunistic CNS Viral Infections in Immunocompromised Patients.pubmed.ncbi.nlm.nih.gov
Case report: From misdiagnosis to timely detection: a clinical and imaging guide to neurological presentations of diffuse large B-cell lymphoma-insights from six cases.pubmed.ncbi.nlm.nih.gov
Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism.pubmed.ncbi.nlm.nih.gov
Diagnosing herpes simplex-1 encephalitis at the time of COVID-19 pandemic.pubmed.ncbi.nlm.nih.gov
Hippocampal Sclerosis After Legionnaires' Disease: A Case Report.pubmed.ncbi.nlm.nih.gov
Occult Amyloid-β-Related Angiitis: Neuroimaging Findings at 1.5T, 3T, and 7T MRI.pubmed.ncbi.nlm.nih.gov
Acute Hemorrhagic Leukoencephalitis (AHLE): A Comprehensive Review on Causes, Symptoms, Link with COVID-19, Diagnosis, and Treatment.pubmed.ncbi.nlm.nih.gov
Posterior reversible encephalopathy syndrome (PRES): A narrative review of pathophysiology, clinical insights, and advances in management.pubmed.ncbi.nlm.nih.gov
Evaluation of the Utility of Hybrid PET/MR Neuroimaging in Inflammatory Demyelination and Encephalitis.pubmed.ncbi.nlm.nih.gov
Comprehensive review of post-treatment imaging in head and neck cancers: from expected to unexpected and beyond.pubmed.ncbi.nlm.nih.gov
The clinical and predictive value of 18F-FDG PET/CT metabolic patterns in a clinical Chinese cohort with autoimmune encephalitis.pubmed.ncbi.nlm.nih.gov
Searching for the elusive neural substrates of body part terms: a neuropsychological study.pubmed.ncbi.nlm.nih.gov
Case Report: severe Mycoplasma pneumoniae-associated acute disseminated encephalomyelitis in an adult: challenges in diagnosis and management.pubmed.ncbi.nlm.nih.gov
Severe Influenza B-associated Encephalopathy With Vocal Cord Paralysis in an Otherwise Healthy Adolescent: A Case Report.pubmed.ncbi.nlm.nih.gov
Catatonia in the Context of Emerging Psychosis: Diagnostic and Therapeutic Challenges in Adolescent Psychiatry.pubmed.ncbi.nlm.nih.gov
Multi-modal lesion mapping of expressive aprosodia.pubmed.ncbi.nlm.nih.gov
Infectious meningitis and encephalitis: A primer for acute care practitioners.pubmed.ncbi.nlm.nih.gov
Autoimmune Encephalitis in Later Life: A Missed Opportunity in Routine Geriatric Care.pubmed.ncbi.nlm.nih.gov
Seizure As the Sentinel Event: An Atypical Presentation of Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis in a Young Adult Male.pubmed.ncbi.nlm.nih.gov
Case Report: Paralytic ileus as an early manifestation of evolving neuroleptic malignant syndrome in a patient receiving anti-psychotics.pubmed.ncbi.nlm.nih.gov
Guillain-Barré Syndrome Following Influenza Vaccination: Diagnostic Challenges in an Uncommon Presentation.pubmed.ncbi.nlm.nih.gov
Dropped head syndrome as the sole presenting manifestation of probable post-cytomegalovirus immune-mediated brainstem encephalitis in an immunocompetent woman: a case report.pubmed.ncbi.nlm.nih.gov
Bilateral temporal lobe disease: looking beyond herpes encephalitis.pubmed.ncbi.nlm.nih.gov
Use of Slow Low-Efficiency Dialysis in a Patient With Status Epilepticus Secondary to Herpes Simplex Encephalitis With Severe Acute Kidney Injury.pubmed.ncbi.nlm.nih.gov
Neurosyphilis Concurrently Presenting With Limbic Encephalitis and Normal Pressure Hydrocephalus: A Case Report.pubmed.ncbi.nlm.nih.gov
Immune-Related Encephalitis in a Patient With Pleural Mesothelioma: Case Report.pubmed.ncbi.nlm.nih.gov
Anti leucine-rich glioma-inactivated 1 (LGI1) antibody-positive limbic encephalitis with evolving basal ganglia T1WI hyperintensity: A case report.pubmed.ncbi.nlm.nih.gov
Case Report: Myelin oligodendrocyte glycoprotein antibody-associated cortical encephalitis masked by peri-ictal magnetic resonance imaging abnormalities.pubmed.ncbi.nlm.nih.gov
Acute Binge Alcohol Consumption Presenting With a Cytotoxic Lesion of the Corpus Callosum (CLOCC) in a Young, Healthy Filipino Male: A Case Report With Features Overlapping the Proposed Marchiafava-Bignami Disease Spectrum.pubmed.ncbi.nlm.nih.gov
Herpes simplex viral encephalitis with acute memory impairment and low cellular cerebrospinal fluid: A case report with systematic review literature.pubmed.ncbi.nlm.nih.gov
Alternating Hemispheric Episodes in Bilateral Rasmussen Encephalitis: The Crucial Role of Sequential Multimodal Neuroimaging.pubmed.ncbi.nlm.nih.gov
Decompressive Craniectomy With Abdominal Bone Flap Preservation in Herpes Simplex Encephalitis: A Case Report.pubmed.ncbi.nlm.nih.gov
A Systematic Review of Sporadic Creutzfeldt-Jakob Disease: Pathogenesis, Diagnosis, and Therapeutic Attempts.pubmed.ncbi.nlm.nih.gov
18 F-FDG-PET Imaging Patterns in Autoimmune Encephalitis: Impact of Image Analysis on the Results.pubmed.ncbi.nlm.nih.gov
The human frontal lobes and frontal network systems: an evolutionary, clinical, and treatment perspective.pubmed.ncbi.nlm.nih.gov
Herpesvirus infections of the central nervous system in immunocompromised patients.pubmed.ncbi.nlm.nih.gov
Frontotemporal dementia: A unique window on the functional role of the temporal lobes.pubmed.ncbi.nlm.nih.gov
Words and objects at the tip of the left temporal lobe in primary progressive aphasia.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.