Complex viral encephalitis by HSV and CMV mimicking cerebral infarctions: Case report

Abstract Most cerebral infarction patients can present clinically with decreased limb movement. On brain magnetic resonance imaging (MRI), acute infarction areas usually demonstrate restricted diffusion changes (high signal on DWI and low signal on corresponding ADC map). The clinical manifestations of viral encephalitis are more diverse due to viral involvement in various regions of brain, and most of patients present as acute onset, severe headaches, fever, and central nervous system symptoms such as mental status change, seizures, among others. Manifestations of viral encephalitis on MRI vary and some can be difficult to differentiate from cerebral infarction and brain tumor-like lesions, especially when there are multiple viral pathogens involved. We present a case of viral encephalitis caused by both Herpes simplex virus (HSV) type I and Cytomegalovirus (CMV), as confirmed by CSF analysis demonstrating significantly elevated titers of both HSV and CMV IgGs, which responded well clinically with anti-viral treatment.