Long-term cognitive sequelae of acyclovir-treated herpes simplex encephalitis
B. Gordon, O. A. Selnes, J. Hart Jr, D. F. Hanley and R. J. Whitley
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 21205.
Survival from untreated herpes simplex type 1 encephalitis is well known to
be accompanied by severe cognitive impairments. Recently, acyclovir has
been proven to be the most effective available treatment for this disease,
with the expectation that it would appreciably reduce morbidity. We
performed detailed assessments of four consecutive patients who received
acyclovir in the early stages of biopsy-proven herpes encephalitis and who
now have been followed up for 1.5 to 4 years. All four patients showed
definite residual on either clinical or formal neuropsychological testing,
most commonly dysnomia and impaired new learning for both verbal and visual
material, even though three had normal performance on a standard clinical
mental status test. All four patients were unable to function at their
prior level of achievement. Therefore, despite early administration of
acyclovir in herpes encephalitis, long-lasting neuropsychological residua
are likely. Furthermore, cognitive deficits of prognostic importance may
not be detected by clinical screening.
