A 25 year old person presents with acute onset of fever and focal seizures. MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement. The most likely diagnosis is:
Correct Answer: Herpes simplex Encephalitis
Description: Person presenting with acute onset of fever, focal seizures and MRI showing hyperintensity in the temporal lobe and frontal lobe is suffering from herpes simplex encephalitis. It is the most common form of acute viral encephalitis. In adults it is caused by HSV1, in neonates and immunocompromised patients its caused by HSV2. Patients present with fever, headache, seizures and drowsiness. Which later evolves into stupor and coma. Lesions are primarily seen in the temporal lobe and ventral pas of frontal lobe. EEG shows slow wave complexes at a frequency of 2-3 Hz,CSF- shows increased pressure, lymphocytosis and increased protein. PCR analysis of CSF for HSV provides definitve diagnosis. Treatment with antiviral can influence the prognosis and survival when staed early. Ref: Neuroimaging in Dementia By Frederik Barkhof, Page 247; Atlas of Human Infectious Diseases By Heiman, Page 229; Immunization in Practice: A Practical Guide for Health Staff By World Health Organization; Medicine By John S. Axford, C. A. O'Callaghan, Page110
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