Unraveling Herpes Simplex Virus Encephalitis: Diagnosis and Management

Herpes simplex virus (HSV) encephalitis is a rare but critical neurological condition characterized by acute brain inflammation, primarily affecting the temporal lobes. It is caused by HSVs belonging to either type 1 or type 2. Patients typically present with fever, altered mental status, seizures, and focal neurological deficits. Prompt diagnosis through neuroimaging and cerebrospinal fluid (CSF) analysis is essential for initiating antiviral therapy and improving patient outcomes. This report describes a 39-year-old male who presented with high-grade fever, neck rigidity, headache, vomiting, disorientation, and episodes of aggression. Neuroimaging revealed a hemorrhagic contusion in the left temporal lobe, whereas CSF analysis confirmed HSV DNA. The patient was started on intravenous acyclovir alongside seizure prophylaxis and supportive care, including antibiotics to rule out bacterial meningitis. Early intervention led to stabilization of symptoms and prevention of complications. During follow-up, the patient demonstrated significant improvement. After 3 weeks of antiviral therapy, his cognitive function improved, with no further seizures or behavioral disturbances. Outpatient follow-up confirmed a near-complete recovery with mild residual cognitive deficits addressed through rehabilitation. This case highlights the importance of recognizing HSV encephalitis, even in atypical presentations such as aggressive behavior and severe cognitive impairment. Early diagnosis and treatment remain critical in reducing morbidity and mortality. A multidisciplinary approach, incorporating antiviral therapy and long-term follow-up, ensures better outcomes and minimizes the risk of permanent neurological deficits.