What are the signs and symptoms of herpes simplex virus (HSV) infection of the CNS?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Herpes simplex virus is the most common cause of sporadic encephalitis in the United States. [54, 55, 56]  and HSV-1 is the second most commonly identified cause of encephalitis in children (behind only enterovirus encephalitis). [57] One third of all cases of herpes simplex virus encephalitis are believed to occur in the pediatric population.

Herpes simplex virus encephalitis may be a manifestation of primary or recurrent infection with the virus. The infection may have an insidious or an abrupt onset. Patients present with headache, altered consciousness, and focal neurological abnormalities (often consistent with temporal lobe involvement).

Aseptic meningitis caused by herpes simplex virus can occur after primary genital HSV-2 infection. Patients with herpes simplex virus meningitis present with headache, fever, stiff neck, and photophobia. Symptoms usually begin 3-12 days after the onset of genital lesions. They reach maximum severity by 2-4 days into the illness, and gradually diminish over 2-3 days.

Dysfunction of the autonomic nervous system and transverse myelitis has been associated with genital herpes simplex virus infection. Symptoms may include hyperesthesia or anesthesia of the lower back, perineum, or sacral region. Urinary retention and constipation are other associated symptoms.

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