Physiotherapy and Functional Recovery in a Rare Case of Herpes Simplex Encephalitis

Background: Herpes simplex encephalitis (HSE) is the most common cause of sporadic viral encephalitis. It typically presents with fever, seizures, and altered mental status. If untreated, mortality can reach 70%, and among survivors, 20–60% experience long-term cognitive or functional impairment. Case Study: A 49-year-old female with well-controlled hypertension presented with sudden quadriparesis and aphasia, initially raising concern for a cerebrovascular event. However, her course evolved atypically for stroke, with progressive confusion, seizures, and cognitive decline. MRI showed temporal lobe hyperintensities, and CSF PCR confirmed HSV-1 infection, establishing herpes simplex virus encephalitis. Following acute medical management, she received an eight-week structured physiotherapy and cognitive rehabilitation program. Interventions included gait and balance training, strengthening, and functional retraining. Outcome measures such as Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Barthel Index (BI) demonstrated marked improvements in mobility, independence, and cognition. Conclusion: This case highlights the diagnostic challenge of HSE, which can mimic stroke and Parkinsonism, while also demonstrating the potential of structured physiotherapy to achieve meaningful functional and cognitive recovery. The co-occurrence of acute cognitive changes, motor deficits, and behavioral disturbances with temporal lobe MRI abnormalities should alert clinicians to this potentially treatable disease, particularly in regions with limited diagnostic resources.