No, Brain Biopsy Need Not Be Done in Every Patient Suspected of Having Herpes Simplex Encephalitis

The recognition of herpes simplex as the cause of viral encephalitis has become increasingly important with the availability of acyclovir for its treatment. The drug has improved substantially the serious morbidity and mortality of herpes simplex encephalitis (HSE). This has made early treatment essential in suspected cases because treatment begun after the onset of coma diminishes greatly the chance of a good outcome. A recent Scandinavian symposium on herpes virus infections and acyclovir summarizes the literature through 1984.1 The conventional wisdom regarding the role of temporal lobe biopsy in establishing the diagnosis of herpes simplex encephalitis has been well stated by Drs Hanley, Johnson, and Whitley in their thoughtful analysis of the problem. They emphasize also that other diagnoses have been established in some cases by the biopsy. There is no doubt that tissue diagnosis is invaluable in studying the epidemiology of the viral encephalitides. But, should biopsy