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A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology

Lookup NU author(s): Emeritus Professor Martin Eccles



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2017 Defres et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objectives To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy. Methods The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting. Results Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids. Conclusions This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.

Publication metadata

Author(s): Defres S, Keller SS, Das K, Vidyasagar R, Parkes LM, Burnside G, Griffiths M, Kopelman M, Roberts N, Solomon T, Backman R, Baker G, Beeching N, Breen R, Brown D, Cheyne C, Carrol E, Davies N, Easton A, Eccles M, Foy R, Garcia-Finana M, Granerod J, Griem J, Gummery A, Harris L, Hickey H, Hill H, Jacoby A, Hardwick H, Kierans C, Cooper J, Kneen R, Lancaster G, Levin M, McDonald R, Medina-Lara A, Menson E, Michael B, Martin N, Sadarangani M, Pennington A, Pollard A, Riley J, Salter AC, Thornton M, Vincent A, Warlow C

Publication type: Article

Publication status: Published

Journal: PLoS One

Year: 2017

Volume: 12

Issue: 1

Online publication date: 26/01/2017

Acceptance date: 02/01/2017

Date deposited: 25/04/2017

ISSN (electronic): 1932-6203

Publisher: Public Library of Science


DOI: 10.1371/journal.pone.0170215


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Funder referenceFunder name
RP-PG-0108-10048National Institute for Health Research (NIHR)