Decompressive craniectomy for herpes simplex encephalitis complicated by frank intracerebral hemorrhage: A case report and review of the literature 11 Medical and Health Sciences 1103 Clinical Sciences

Yoon Hwan Byun, Eun Jin Ha, Sang-Bae Ko, Kyung Hyun Kim

Research output: Contribution to journalArticle

Abstract

Background: Herpes simplex encephalitis is the most common type of sporadic encephalitis worldwide. Frank intracerebral hemorrhage complicating the disease course in herpes simplex encephalitis patients is rare, especially cases where surgical decompression is necessary. Here, we report a previously healthy female with herpes simplex encephalitis who underwent surgical decompression due to temporal lobe hemorrhage. Case presentation: A previously healthy 34-year-old Korean female presented with fever, myalgia and severe headache. Brain MRI showed a high T2 signal intensity change and diffuse swelling of the right temporal lobe. Polymerase chain reaction testing of the cerebrospinal fluid confirmed the presence of herpes simplex virus 1. The patient was admitted for close observation and intravenous acyclovir. On hospital day 3, she had a sudden onset of vomiting and severe headache. Brain CT showed frank temporal lobe hemorrhage. Despite aggressive medical treatment, she became increasingly drowsy. Ultimately, she underwent emergency right decompressive craniectomy, expansile duraplasty and intracranial pressure monitor insertion. The patient recovered fully without any neurological deficits or neuropsychological problems. She was discharged after completion of 2 weeks of acyclovir and returned 2 months later for cranioplasty. Conclusions: Patients with severe herpes simplex encephalitis complicated by intracerebral hemorrhage or malignant cerebral edema should undergo aggressive medical treatment. Surgical decompression should also be actively considered in these severe cases to prevent further neurological deterioration.

Original languageEnglish
Article number176
JournalBMC Neurology
Volume18
Issue number1
DOIs
StatePublished - 23 Oct 2018

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Decompressive Craniectomy
Herpes Simplex Encephalitis
Cerebral Hemorrhage
Surgical Decompression
Temporal Lobe
Acyclovir
Health
Headache
Hemorrhage
Myalgia
Brain Edema
Intracranial Pressure
Brain
Human Herpesvirus 1
Encephalitis
Vomiting
Cerebrospinal Fluid
Emergencies
Fever
Observation

Keywords

  • Herpes simplex encephalitis
  • Intracerebral hemorrhage
  • Surgical decompression

Cite this

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title = "Decompressive craniectomy for herpes simplex encephalitis complicated by frank intracerebral hemorrhage: A case report and review of the literature 11 Medical and Health Sciences 1103 Clinical Sciences",
abstract = "Background: Herpes simplex encephalitis is the most common type of sporadic encephalitis worldwide. Frank intracerebral hemorrhage complicating the disease course in herpes simplex encephalitis patients is rare, especially cases where surgical decompression is necessary. Here, we report a previously healthy female with herpes simplex encephalitis who underwent surgical decompression due to temporal lobe hemorrhage. Case presentation: A previously healthy 34-year-old Korean female presented with fever, myalgia and severe headache. Brain MRI showed a high T2 signal intensity change and diffuse swelling of the right temporal lobe. Polymerase chain reaction testing of the cerebrospinal fluid confirmed the presence of herpes simplex virus 1. The patient was admitted for close observation and intravenous acyclovir. On hospital day 3, she had a sudden onset of vomiting and severe headache. Brain CT showed frank temporal lobe hemorrhage. Despite aggressive medical treatment, she became increasingly drowsy. Ultimately, she underwent emergency right decompressive craniectomy, expansile duraplasty and intracranial pressure monitor insertion. The patient recovered fully without any neurological deficits or neuropsychological problems. She was discharged after completion of 2 weeks of acyclovir and returned 2 months later for cranioplasty. Conclusions: Patients with severe herpes simplex encephalitis complicated by intracerebral hemorrhage or malignant cerebral edema should undergo aggressive medical treatment. Surgical decompression should also be actively considered in these severe cases to prevent further neurological deterioration.",
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