RECURRENT BRAIN-STEM ENCEPHALITIS ASSOCIATED WITH HERPES-SIMPLEX VIRUS TYPE-1 DNA IN CEREBROSPINAL-FLUID

A 47-year-old man had recurrent signs and symptoms of brainstem enceph alitis over a 4-year period. Although CSF viral cultures were repeated ly negative, herpes simplex virus type 1 (HSV-1) DNA was detected in C SF by polymerase chain reaction (PCR). HSV-1-specific antibodies were absent at the time of the first positive PCR test, but CSF seroconvers ion to high HSV-1-specific antibody titer subsequently occurred. CSF a ntibody to cytomegalovirus (CMV) and varicella-zoster virus (VZV) was not detectable, nor could CMV, VZV, or Epstein-Barr virus nucleic acid be detected in CSF by PCR, This is the first report of the use of CSF PCR for the rapid antemortem diagnosis of herpetic brainstem encephal itis.