SFGH report pearls 8.26: HSV 2 meningitis

  • HSV type 1 is the most common cause of sporadic, acute focal encephalitis
  • HSV type 2 is the most common cause of aseptic meningitis associated with HSV
  • can include confusion, focal neurologic manifestations, and cranial neuropathies
    • evidence is limited, but a course of IV acyclovir followed by an oral agent is typical
  • 85 percent of patients with primary HSV-2 meningitis have genital lesions which are often present a week prior to CNS symptoms
  • O’Sullivan CE, Aksamit AJ, Harrington JR, Harmsen WS, Mitchell PS, Patel R.  Clinical spectrum and laboratory characteristics associated with detection of herpes simplex virus DNA in cerebrospinal fluid. Mayo Clin Proc. 2003 Nov; 78(11): 1347-52.
  • Kupila et al. Etiology of aseptic meningitis and encephalitis in an adult population.  Neurology. 2006; 66(1):75.
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