Atypical herpes simplex encephalitis presenting as operculum syndrome

This case report demonstrates the course of herpes simplex virus cerebritis in a patient aged 7 years 2 months who presented with non-specific symptom s followed by an epileptic attack. Subcortical, bilateral opercular and bil ateral thalamic lesions were detected, but the temporal and inferior fronta l lobes were spared. The patient developed anarthria, impairment of mastica tion and swallowing consistent with operculum syndrome. Diagnosis was made by magnetic resonance imaging and elevation of oligoclonal antibodies speci fic to herpes simplex virus in cerebrospinal fluid after an unexpectedly ne gative polymerase chain reaction test.