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We report the case of pathologically proved atypical herpes simplex encephalitis (HSE) in a 40-year-old male patient with AIDS who was followed up by MR imaging, which included diffusion-weighted imaging and proton MR spectroscopy (1H-MRS). MR revealed sparing of hippocampi and limbic cortices, necrosis of both cingulated gyri, and cerebellar involvement. Increased diffusivity and severe metabolic alterations were compatible with biopsy findings of necrotizing inflammation. Clinical recovery corresponded with partial metabolite and diffusion normalization and a myo-inositol increase that indicated evolving gliosis formation further corroborated by immunohistochemistry results. 1H-MRS and diffusion-weighted imaging may both support the diagnosis of HSE in patients with AIDS and help in the follow-up of necrotizing inflammation. |
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acquired immunodeficiency syndrome brain biopsy cerebellar lesion encephalitis encephalitis,focal herpes simplex encephalitis herpes simplex encephalitis,atypical herpes simplex virus infection,immunosuppressed patient human immunodeficiency virus type 1 immunodeficiency immunohistochemistry immunosuppression inclusion bodies inclusion bodies,eosinophilic intranuclear inclusion bodies,intranuclear MRI MRI,abnormal MRI,diffusion weighted MRS neuropathology opportunistic infection polymerase chain reaction polymerase chain reaction,false negative
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