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Purpose <p>Herpes simplex virus 1 encephalitis (HSE) is the most common sporadic infectious encephalitis in Western countries, with a 70% mortality rate and only 9% of survivors free from neurological sequelae. While definitive diagnosis relies on cerebrospinal fluid testing, magnetic resonance imaging (MRI) plays a crucial role in identifying typical acute patterns and features. However, the imaging evolution of encephalitic lesions is not well understood. We aimed to identify and evaluate the prevalence and progression of cortical lesions, as well as the recurrence of these patterns in HSE and other encephalitic etiologies.</p> Methods <p>As a retrospective monocentric study, we included 40 patients with various etiological encephalitis from our institute. Each patient’s lesions were assessed, by three experienced neuroradiologists, in the acute phase and associated with specific evolution patterns in the chronic phase.</p> Results <p>10 out of 11 (91%) patients diagnosed with HSV-1 presented during chronic phase selective cortical liquefaction, identified as Cortical Melt Sign (CMS) (Fisher’s exact p-value &lt; 0.001). Moreover, this pattern was then correlated with acute diffusion restriction—potentially explaining CMS as a chronic imaging biomarker for HSE as a result of the acute inflammation.</p> Conclusion <p>These findings can aid in understanding the pathological mechanisms of herpetic encephalitis and guide differential diagnosis. Moreover, CMS could serve as a retrospective imaging marker in HSE.</p>

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Cortical melt sign: a novel imaging biomarker for pediatric herpes simplex encephalitis

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Martina Resaz,
  • Costanza Parodi,
  • Sofia Panzeri,
  • Antonia Ramaglia,
  • Joaquín Vallejos Espíndola,
  • Mariasavina Severino,
  • Domenico Tortora,
  • Giulia Nobile,
  • Elio Castagnola,
  • Margherita Mancardi,
  • Andrea Rossi

摘要

Purpose

Herpes simplex virus 1 encephalitis (HSE) is the most common sporadic infectious encephalitis in Western countries, with a 70% mortality rate and only 9% of survivors free from neurological sequelae. While definitive diagnosis relies on cerebrospinal fluid testing, magnetic resonance imaging (MRI) plays a crucial role in identifying typical acute patterns and features. However, the imaging evolution of encephalitic lesions is not well understood. We aimed to identify and evaluate the prevalence and progression of cortical lesions, as well as the recurrence of these patterns in HSE and other encephalitic etiologies.

Methods

As a retrospective monocentric study, we included 40 patients with various etiological encephalitis from our institute. Each patient’s lesions were assessed, by three experienced neuroradiologists, in the acute phase and associated with specific evolution patterns in the chronic phase.

Results

10 out of 11 (91%) patients diagnosed with HSV-1 presented during chronic phase selective cortical liquefaction, identified as Cortical Melt Sign (CMS) (Fisher’s exact p-value < 0.001). Moreover, this pattern was then correlated with acute diffusion restriction—potentially explaining CMS as a chronic imaging biomarker for HSE as a result of the acute inflammation.

Conclusion

These findings can aid in understanding the pathological mechanisms of herpetic encephalitis and guide differential diagnosis. Moreover, CMS could serve as a retrospective imaging marker in HSE.