Two cases of neonatal herpes encephalitis that showed an apparent uneventful recovery had concurrent severe, diffuse cerebral imaging abnormalities, in a report from Gillette Children's Specialty Healthcare, St Paul, and Children's Hospital, Minneapolis, MN. Despite prompt treatment with acyclovir and a favorable convalescence, imaging revealed severe diffuse cerebral infarction, discordant with the clinical findings. The prognosis was ultimately malignant. [1]

COMMENT. The initial discordance of clinical response to acyclovir and brain imaging abnormalities indicates the need for serial CT or MRI during treatment of neonatal herpes encephalitis.