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Images in Neurology |

Acute Retinal Necrosis Following Herpes Simplex Encephalitis

Shiro Yamamoto, MD; Takeshi Nakao, MD; Koji Kajiyama, MD, PhD
Arch Neurol. 2007;64(2):283. doi:10.1001/archneur.64.2.283.
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A 63-year-old man with a history of diabetes mellitus and angina had fever, pulsating headache, and vomiting 5 days before admission. On admission, he was not alert and was disoriented. Neurological examinations showed Wernicke aphasia, memory disturbance, dyscalculia, and construction apraxia. The cerebrospinal fluid had an increased number of lymphocytes (117/μL) and elevated protein levels (113 mg/dL), and polymerase chain reaction results were positive for herpes simplex virus. Fluid-attenuated inversion recovery magnetic resonance imaging revealed hyperintense signals in the temporal lobe and insular cortex of the left hemisphere as well as small lesions in the right subcortical area (Figure 1).

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Left eye. A, Retinal hemorrhages (arrows) in the fundus. B, Three months later, retinal detachment and necrosis were revealed in the fundus. Arrows indicate the edge of the detachment.

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Figure 1

Fluid-attenuated inversion recovery magnetic resonance imaging revealed hyperintensity in the temporal lobe, insular cortex of the left hemisphere, and the right subcortical area.

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