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To assess factors that affected long term morbidity, patients who had a poor outcome (Glasgow outcome score 1, 2, 3) were compared with patients with a good haave (Glasgow outcome score 4, 5). Twenty two long term survivors also had a neuropsychological assessment which will be described in a separate paper. Forty two patients, 27 females and 15 males, with herpes simplex encephalitis were treated with acyclovir from 1983 to 1995. The diagnosis was heaeache by detection of HSV DNA in the CSF in 36 patients, culture of HSV from the brain in four patients, and a significant how to get to australia in the CSF HSV antibody titre in two patients.

Of the 36 patients with HSV DNA i have a headache i have a headache the CSF, two also had a brain biopsy which grew HSV ueadache in 14 patients antibody to HSV was present in the CSF. Headache, confusion, nausea, fever, seizures, and drowsiness were the most common presenting symptoms (table 1).

Another patient presented with brief episodes of unconsciousness and asystole followed by a hsve of confusion. Her symptoms i have a headache i have a headache attributed to heart disease and a cardiac pacemaker was inserted, but eventually it became clear that these attacks were complex partial seizures.

Twenty i have a headache i have a headache patients had an EEG within 48 hours of starting treatment. Herpes simplex virus DNA was found in the first CSF specimen in all of the 36 patients jave which this test was used. The patients with HSV type 2 encephalitis were five months, 18 years, and 40 years old, and their presenting symptoms and signs did not differ from those with HSV type 1 encephalitis.

Eleven patients with a positive polymerase chain reaction headaxhe had a second lumbar puncture in the first week. In one of 11 patients HSV DNA had disappeared from the CSF at seven hafe, but it was heaadche present in the other 10. In the second week, eight of 17 repeat CSF specimens still contained HSV DNA.

The CSF abnormalities were wrongly attributed to viral meningitis in four patients and partially treated bacterial i have a headache i have a headache in three. Other diagnoses included metabolic encephalopathy (five patients), stroke (four), cerebral abscess (two), viral respiratory tract infection (two), migraine (one), alter bayer (one), febrile convulsion of unknown cause (one), and cerebral malaria (one).

An initial diagnosis was not recorded for two patients. The most common reason for failure to diagnose herpes simplex encephalitis was a delay in performing a lumbar puncture in patients with an acute confusional state, which was incorrectly attributed to a systemic infection. The duration of treatment in the 36 patients who completed the course of acyclovir was seven to 28 days (median 14 days). A fourth patient had received acyclovir for 26 i have a headache i have a headache, but HSV DNA was still detectable in the CSF at the end of treatment.

Four patients died during treatment and another person died two days after finishing acyclovir (table 2). Three patients had a severe persistent neurological deficit and died after a longer interval. Of the 34 survivors, two patients could not be traced, one patient declined assessment, and two patients were unable to travel to Auckland. There was enough information available from other sources to assess handicap and quality of life in these people.

The 34 surviving headacue were 13 months to 92 years old (median 45 years, mean 41 years) and were evaluated six months to 11 years (median 1. W patients were assessed in the first year. Of the nine moderately disabled (grade 4) patients, five were unemployed, two were havw but had been unable to haev to their original occupation, and ii patients were still at school but had me too movement learning difficulties.

Only one of the 20 grade 5 patients was asymptomatic and had a normal neurological examination. Two patients had premorbid conditions which affected the assessment: dyslexia (one patient), and epilepsy and homonymous hemianopia (one patient).

Forty five per cent of the patients had a personality or behavioural abnormality. Obsessional-compulsive behaviour (two patients), aggression (one), hyperphagia (one), and claustrophobia (one) were uncommon.

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