7/F/6 months Yes (38) 2–23 h Short report 2/F/4 months 3/M/5 months Yes† (NK) Yes (38.2) 4/M/6 months Yes (38.2) 5/M/6 months Yes (38) 6/F/6 months Yes (38.8) 8/M/8 months Yes (38.5) 9/F/10 months Yes (NK) 10/F/10 months Yes (38.5) 12/F/11 months 13/F/11 months Yes (39.5) Yes (38.6) 14/F/14 months Yes (37.8) 15/F/17 months No 16/F/17 months 17/F/18 months 18/M/26 months 19/M/35 months Yes (39.2) Yes (39.0) Yes (37.5) Yes (38.5) Table 2 HSV CNS infection: clinical features, neuroimaging and long-term outcome Patient (n/sex/age) Fever (°C) Encephalopathy Convulsions (duration) Lesions on CT Lesions on MRI Outcome (time after discharge*) 1/F/3 months Yes (39.2) 2–23 h Whole body (>30 min) ≥24 h ≥24 h ≥24 h ≥24 h ≥24 h ≥24 h ≥24 h ≥24 h ≥24 h <2 h 2–23 h ≥24 h NK§ <2 h 2–23 h ≥24 h 2–23 h ND ND ND ND ND ND ND ND ND ND R cerebral hemisphere R and L frontal and temporal, R pari- etal oedema and haemorrhage ND R temporal – no normal parenchyma ND R temporal hae- morrhagic and L temporal, parietal and occipital R and L haemor- rhagic parietal and parasagittal Diffuse high signal in white matter around ventricles Normal Developmental delay (cognitive and motor), spastic quadriplegia, blind, whole body convulsions (2 years) Developmental delay (cognitive), behavioural problems (4 years) Developmental delay (cognitive and motor), hypotonia, L homony- mous hemianopia (10 months) Developmental delay (cognitive and motor), L hemiplegia, whole body convulsions (3 years) Developmental delay (cognitive and motor), L hemiplegia and con- vulsions (2 years) Developmental delay (cognitive and motor), L homonymous hemi- anopia (1.5 years) Developmental delay (cognitive and motor), quadriparesis, convul- sions, atonic attacks (2.5 years) Recovered (1 year) Developmental delay (cognitive and motor), autism, convulsions (4 years) Developmental delay (cognitive) (1 year) Developmental delay (cognitive and motor), R hemiplegia, R hom- onymous hemianopia, convulsions (2 years) Recovered (2 years) Needs speech therapy (2 years) Recovered (NK) Convulsions, absences but attends normal school (2.5 years) Recovered (1 year) Hemiparesis (2.5 years) Developmental delay (motor and cognitive) (4 years) Recovered (3.5 years) Partial, L hemiclonic (>30 min) Partial (<15 min) Partial (>30 min) and L hemiplegia ≥24 h Partial L-sided (>30 min) and L hemiplegia ≥24 h Partial motor (>30 min) and L hemiplegia ≥24 h Whole body (>30 min) Partial, R-sided with oculogyric crisis (>30 min) Whole body (15–30 min) Whole body (<15 min) Partial (15–30 min) and Todd’s paresis‡ Partial, R-sided (>30 min) and Todd’s paresis Partial, clonic R arm (15–30 min) Whole body (>30 min) Whole body (>30 min) Whole body (<15 min) and ataxia ≥24 h Partial (>30 min), ataxia ≥24 h Partial and whole body (15–30 min) and ataxia ≥24 h Haemorrhagic R and L hemispheres, oedema Haemorrhagic R and L temporal and parietal Haemorrhagic R and L parietal, low density R and L temporal and R parieto-occipital Low density bifrontal Haemorrhagic, low den- sity L frontal, temporal and parietal R parietal, occipital Low density frontal, temporal, parietal Low density temporal lobe Low density R temporal and parietal Low density R and L temporal lobe, ser- piginous enhancement R sylvian ﬁssure Low density L temporal lobe Low density L temporal Haemorrhagic R parietal lobe Normal Normal Normal Normal Normal Normal 11/F/10 months Yes (39) Partial (>30 min) *Depended on date child last seen and date of return of the questionnaire. †Preceding admission. ‡Hemiplegia for <24 h. §Ictal, given thiopentone and transferred to paediatric intensive care unit at another hospital. Patient described as encephalopathic but duration not given – not possible to differentiate drug-induced from virus-induced encephalopathy. CNS, central nervous system; HSV, herpes simplex virus; ND, not done; NK, not known. Indeed, nowadays CSF is rarely tested for intrathecal HSV antibody4 and this was certainly our experience. Finally, the declining use of HSV serum antibody tests together with a decrease in the use of lumbar puncture in paediatric practice may have affected detection.5 However, it seems that in fact few cases were missed. Analysis of Hospital Episode Statistics (HES) for England over 1998–2001 gives 52 cases of HSE in children <3 years old (data not shown). This ﬁgure is necessar- ily higher than ours since it includes neonates in whom HSE occurs in appreciable numbers (76 cases in 1986–1991, 83 cases in 2004–2006).6 Thus, although the HES data lack conﬁrma- tory virological evidence and a uniform case deﬁnition, they 164 Arch Dis Child 2012;97:162–165. doi:10.1136/adc.2010.204677