HERPES-SIMPLEX VIRUS MYELITIS - CLINICAL MANIFESTATIONS AND DIAGNOSISBY THE POLYMERASE-CHAIN-REACTION METHOD

Herpes simplex virus (HSV) myelitis has previously been reported to be a form of acute ascending necrotizing myelitis caused by HSV type 2 ( HSV-2). We studied neurological symptoms, clinical course, magnetic re sonance imaging (MRI) findings, and diagnosis by polymerase chain reac tion (PCR) methods in 9 patients with HSV myelitis. In 6 cases, diseas e onset was marked by sensorimotor disturbances of lower extremities a nd urinary disturbances, with the transverse myelopathy gradually asce nding to the cervicothoracic spinal cord level. The other 3 cases show ed transverse myelopathy without an ascending pattern. Six cases showe d acute progression, while 3 cases showed a subacute course. There wer e 2 cases with recurrent episodes. Three patients recovered, however, in the remaining 6 patients severe sequelae such as paraplegia persist ed despite antiviral therapy. MRI showed a hyperintense lesion on T2-w eighted images. Gadolinium enhancement was observed in 2 cases, and 1 case showed a hyperintense lesion both on T1- and on T2-weighted image s, suggesting hemorrhagic necrosis. HSV-2 was detected by PCR techniqu es in all 6 cases with an ascending pattern. HSV-1 DNA was detected in 2 and HSV-2 DNA in 1 of the 3 cases with a nonascending pattern. Our findings demonstrate diverse clinical manifestations of HSV myelitis.