Intracerebral haematoma formation in herpes simplex encephalitis: a case report

Intracranial Hemorrhage Complicating Herpes Simplex Encephalitis on Antiviral Therapy: A Case Report and Review of the Literature

Herpes simplex virus (HSV) encephalitis is the most common cause of nonendemic sporadic encephalitis in the USA. Decreased mortality with early treatment with acyclovir has been documented. Although common complications include cortical petechial hemorrhages, frank intracerebral hematomas are considered very rare. Only few cases have been reported in the literature. We report a case of HSV encephalitis complicated by intracerebral hemorrhage 12 days after initiation of acyclovir therapy.

Intracerebral haemorrhage as a rare complication of HSV-1 meningoencephalitis: Case report and review of the literature

We present a case of herpetic meningoencephalitis confirmed by PCR in a 22-y-old male, with accompanying appearance of a large intracerebral haematoma as a complication. Despite the impressive imaging findings, the final outcome of the patient's progress was favourable.

An unusual late complication of intracerebral haematoma in herpes encephalitis after successful acyclovir treatment

This is a case report of PCR proven herpes simplex (HSV-1) encephalitis in a 26 years old immunocompetent adult taking an unusual course of acute intracerebral haematoma after successful and complete recovery with acyclovir therapy. This transient late complication was associated with a negative repeat CSF PCR for HSV suggesting that the initial 14 days course of acyclovir was successful in the eradication of the herpes virus infection as recommended by the International Herpes Management Forum (IHMF). The location of the haematoma corresponded to the initial encephalitic area involving the medial temporal lobe structures. Despite this late neuroradiologic complication, after day 18 of symptom onset, the patient had a favourable neurological outcome. To the best of our knowledge, this is the second report of the unusual, rare, and late neuroimaging complication of acute intracerebral haematoma formation after complete recovery from treated HSVE with favourable clinical outcome. The literature is reviewed and plausible aetiology is discussed.

Herpes simplex encephalitis. Is anticoagulation safe?

BACKGROUND

Herpes simplex encephalitis (HSE) still carries a high morbidity and mortality.

REVIEW SUMMARY

The authors report a 27-year-old patient who presented with an HSE manifested by a high temperature, seizures, and headaches. His hospitalization course was complicated by a pulmonary embolism. After anticoagulation was started, the patient developed a right temporal hematoma at the same region of the abnormal signal on magnetic resonance imaging. The patient underwent a craniotomy and evacuation of the hematoma with an uneventful postoperative outcome.

CONCLUSION

The safety of anticoagulation in HSE has not been raised in the literature previously, and it needs further study.

Intracranial hemorrhage in herpes simplex encephalitis: an unusual presentation

We describe a 14-month-old patient with atypical presentation of herpes simplex encephalitis. She initially presented with fever, lethargy, seizures, and large hemorrhages in the right parietal lobe, and clinical findings suggestive of a hypercoagulable state. The etiology of coagulation abnormality was not identified, although it was suggested as a possible causative factor in severe bleeding along with acute neuronal lysis as a result of infection. Although large intracerebral hemorrhages are occasionally described with systemic herpes infection, this presentation is unusual beyond the infant period.