Herpes Encephalitis

What is herpes encephalitis?

Herpes encephalitis is an uncommon but life-threatening problem caused by infection with the herpes virus. Encephalitis is an irritation or infection of the brain and central nervous system.

How does it occur?

The herpes virus usually causes a skin infection. It causes painful blisters that last for several days. The blisters may start as cold sores or fever blisters around the mouth, or they may start as sores in the genital or buttocks area. The virus can be spread from the blisters to other parts of the body and to other people.

There are several ways the virus might infect the brain and nervous system.

• In between outbreaks on the skin, the herpes virus lives in nerve cells close to the spinal column. The virus may spread from these areas into the spinal fluid that cushions the brain and spinal cord.
• The herpes virus may get into the central nervous system through herpes infections in the head and neck, including the ears. Many people have herpes infections inside their noses or inside their ears. These areas are separated from the central nervous system by very thin bones and membranes, which the virus can pass through.
• The virus may spread to a newborn during delivery if the mother has herpes sores in the genital area. When this happens, the baby may have a total body herpes infection, including the central nervous system.

What are the symptoms?

The symptoms of herpes encephalitis are similar to the symptoms of meningitis, a stroke, or epilepsy: They may change from mild to severe within several days or even several hours.

• At first the infection may cause flulike symptoms, including fever and muscle aches, especially headache.
• There can be personality changes, confusion, hallucinations, and memory problems. Someone who is developing encephalitis is often not able to talk.
• The infection may then cause a gradual decrease in awareness. There may be disorientation, confusion, and seizures. Coma may follow.

If you think you or someone else may have encephalitis, it is very important to contact your healthcare provider right away.

How is it diagnosed?

The diagnosis can be difficult. Because herpes encephalitis is rare and can look like more common emergency medical problems, such as a stroke, your medical history is very important. Your provider will want to know your medical history, including:

• any history of herpes infections
• when and how long you have had symptoms
• other health problems you have that might make it harder for the body to fight infection, such as cancer, diabetes, or autoimmune diseases.

You will have a physical exam.

Lab and X-ray exams may include:

• blood tests to look for signs of infection
• spinal tap (lumbar puncture), which means a sample of spinal fluid is tested for signs of infection
• brain scan--either a CT or MRI scan

How is it treated?

The main treatment is antiviral medicine given by IV (by vein) at the hospital. Because this infection can be life-threatening, the medicine may be started right away, before test results are known. Other treatments depend on your symptoms and your physical condition. For example, if you have brain swelling, medicines can be given to treat it. Or if you stop breathing, you can be put on a respirator. These life-support treatments are used until the medicine gets the virus under control and your condition starts to get better.

How long will the effects last?

It can take a long time to recover from herpes encephalitis. This is especially true if the infection has caused problems such as speech problems, weakness on one side, or balance problems. If the infection was in one particular part of the brain, the symptoms and after-effects will be similar to the effects of a stroke. These effects usually require physical therapy. Because the brain controls thinking and moving, there may be temporary or permanent loss of these abilities.

Herpes encephalitis can be fatal. If a newborn is infected and survives the infection, the baby is likely to have damage to the brain or other parts of the nervous system.

How can I help take care of myself?

If you are recovering from herpes encephalitis, it is important for you to:

• Follow your healthcare provider’s instructions.
• Keep all appointments.
• Work with your physical and occupational therapists so you can be as independent as possible.
• See a counselor if you are getting discouraged or depressed.
• Remember that recovery will take many weeks or months.
• Tell your provider if you are having new symptoms or you feel your treatment is not helping.

What can I do to prevent herpes encephalitis?

While we don't know how to prevent herpes encephalitis, there are ways to try to prevent getting the herpes virus.

• The herpes virus is everywhere in the environment, especially type 1, which is the herpes strain that usually causes cold sores (fever blisters). As with many other infections, frequent and careful hand-washing is the place to start. This is especially important if your work brings you into contact with the public.
• When you have herpes blisters--like a cold sore on the lip—the virus is in the fluid in the blisters and can infect others. When you have blisters:
  • Avoid touching the blisters. If you do touch them, wash your hands as soon as possible. Wash your hands well but gently. You don’t want to damage your skin and create an opening for the virus to get into another part of the body.
  • Don’t share food, drink, or eating utensils.
  • Don’t kiss anyone.
• If you have genital herpes, the fluid in the blistery rash on the genitals is infectious. Do not touch the rash and then touch your eyes or nose, where the infection could be spread. Using condoms can help prevent spread of the herpes virus, but condoms do not cover all areas of the genitals that can have the rash. So it is best not to have intercourse when a rash is present.

It is not clear whether the herpes virus can be spread to others when there are no blisters or rash. This question is being studied by researchers.