Two patients with atypical focal necrotising herpes simplex encephalitis are described. They presented with relatively mild clinical disease but despite treatment with acyclovir (10 mg/kg/day for three days in case 1 and 10 days in case 2) they developed dramatic, progressive changes (shown on brain CT) that mimicked space occupying lesions of the temporal lobes. Both patients therefore had a diagnostic and therapeutic temporal lesionectomy followed by further 10 day courses of acyclovir. They subsequently went on to make good clinical and neuropsychological recoveries.
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