A diagnosis of HSE due to an HSV DNA type 1 infection was made. Victor had some further episodes of facial twitching and an electroencephalogram (EEG) was requested as his behaviour had become very odd and the twitching had worsened. This measures brain electrical activity and records brain wave patterns and can detect subtle motor seizure activity. Victor’s GCS score had fallen to 9 but was still in the moderate range.

Victor gradually improved and after completing 3 weeks of aciclovir treatment a further LP was carried out. The results showed that HSV DNA was negative and the cell count was normal.

He still was left with some dysphasia and would make the odd inappropriate comment, but this improved with neurorehabilitation.

Acute encephalitis is a notifiable disease and is reported to the local authority proper officers under the Health Protection (Notification) Regulations 2010.