Turkish Journal of Geriatrics 2010 , Vol 13, Issue 2
Fahrettin EGE, Aydın GÜLÜNAY, Şerefnur ÖZTÜRK, Yeşim KARADAĞ, Şenay ÖZBAKIR
Ankara Numune Eğitim ve Araştırma Hastanesi 1. Nöroloji Kliniği ANKARA Herpes simplex is the leading cause of sporadic encephalitis in adults. Although the mortality of untreated disease is 50-70%, successful results are obtained with early diagnosis and treatment. Recognition of the signs and the data from imaging techniques is crucial for early treatment. Herpes encephalitis predominantly involves the temporal lobes, however cases with extra-temporal involvement have been rarely reported in the literature. Extra-temporal localizations include parietal, occipital and frontal lobes, as well as basal ganglia and brain stem. A 61 year-old man presented with frontal lobe syndrome characterized by ataxia and urinary incontinence accompanied by confusion, agitation and generalized seizures. Other possible causes were excluded with laboratory, electrophysiology and imaging procedures. Diagnosis was considered to be compatible with herpes encephalitis involving mainly the frontal lobe. Significant clinical improvement was achieved after specific anti-viral therapy. When imaging procedures reveal extra-temporal lesions, the disease should not be excluded in the presence of signs and symptoms of encephalitis. If supporting evidence exists, herpes encephalitis with atypical localization should also be considered in differential diagnosis in elderly patients. Keywords : Herpes encephalitis; Frontal; Cerebrovascular; MRI; EEG; Seizure