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Herpes-simplex-Virus-Enzephalitis: neuroradiologische Differenzialdiagnose

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Die Herpes-simplex-Virus-Enzephalitis ist die häufigste virale Enzephalitis, in der Regel mit Ausgang und Schwerpunkt im Temporallappen. Unbehandelt ist die Prognose als sehr ernst zu betrachten, die frühzeitige Diagnosestellung und Therapie mit Acyclovir daher unerlässlich. Da im frühen Stadium die Computertomographie unauffällig ist, sollte eine MR-Tomographie durchgeführt werden, die schon im frühen Stadium wegweisende Befunde zeigen kann. Empfehlenswert sind koronare Sequenzen in T1-Wichtung, jeweils vor und nach paramagnetischer Kontrastverstärkung, eine koronare FLAIR-Sequenz sowie eine axiale T2-gewichtete Untersuchung. Diagnostisch beweisend ist der Nachweis von Virus-DNA mittels der Polymerase Chain Reaction (PCR) im Liquor cerebrospinalis.


Herpes simplex virus encephalitis (HSE) is the most frequent viral encepahlitis, as a rule with the starting point and centre within the temporal lobe. If untreated, HSE is usually fatal, thus diagnosis has to be established rapidly. Treatment with Acyclovir should begin as soon as possible. As MRI is extremely sensitive in detecting the early inflammatory changes, it should be initially performed, especially as in the early stadium CT may be unspecific.

We recommend the following examination protocol: coronar T1-weighted MR imaging before and after adminstration of gadopentetate dimeglumine, coronar FLAIR sequence and axial T2-weighted imaging. The diagnostic proof is to show the evidence of viral DNA by polymerase chain reaction (PCR) in cerebrospinal liquor.

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Struffert, T., Reith, W. Herpes-simplex-Virus-Enzephalitis: neuroradiologische Differenzialdiagnose. Radiologe 40, 1011–1016 (2000).

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