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

Shelley, Bhaskara P; Raniga, Sameer; Al-Khabouri, Jaber

doi:10.1016/j.jns.2006.10.020

Cited by 15 publications

(9 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was no strict correlation between the initial neurological presentation of HSV‐1 infection and the site of the haematoma, but the lack of detection of the haematoma on the initial CT and MRI scans may reflect the less pronounced CNS clinical signs when the patient was first admitted to hospital. Only a few cases of immediate intracerebral haematoma have been reported in patients with HSV infection [Argyriou et al, 2006; Shelley et al, 2007]. This case differs from previous reports in that no HSV DNA was detected in the second CSF sample and a major cholestatic process associated with unusually late systemic symptoms was observed.…”

Section: Discussionmentioning

confidence: 57%

Case report: Benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression

Chaillon

Schnepf

Jonas

et al. 2012

Journal of Medical Virology

View full text Add to dashboard Cite

Herpes simplex virus (HSV) infection is rarely considered in the differential diagnosis of severe acute hepatitis and disseminated infection in immunocompetent adults. A case of disseminated HSV-1 infection in an 82-year-old woman initially presenting with neurological problems, signs of meningitis and prominent hepatitis was investigated. Initial diagnosis, monitoring, and follow-up were based on the application of molecular methods to cerebrospinal fluid, serum, and liver tissue samples from this patient. Following an initial full recovery, the patient presented delayed intracerebral haemorrhage and diffuse arthralgia. This atypical case, with delayed secondary progression, highlights the wide range of clinical features of HSV infection and the benefits of monitoring viral load by quantitative real-time polymerase chain reaction (PCR) during patient management.

show abstract

Section: Discussionmentioning

confidence: 57%

Case report: Benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression

Chaillon

Schnepf

Jonas

et al. 2012

Journal of Medical Virology

View full text Add to dashboard Cite

show abstract

“…Intracerebral hematoma is rarely associated with HSVE [7] and only 14 cases have so far been reported. To the best of our knowledge, this is the first report to document a case of HSVE associated with subarachnoid bleeding.…”

Section: Discussionmentioning

confidence: 99%

A successfully treated case of herpes simplex encephalitis complicated by subarachnoid bleeding: a case report

et al. 2010

View full text Add to dashboard Cite

IntroductionHistopathologically, herpes simplex virus type 1 causes hemorrhagic necrosis. Overt hemorrhage is infrequent in herpes simplex virus encephalitis but can lead to poor outcomes. This report describes a successfully treated case of herpes simplex virus encephalitis associated with subarachnoid bleeding in which real-time polymerase chain reaction was useful for diagnosis.Case presentationA 30-year-old previously healthy Japanese woman who had fever and headache for five days presented with disorganised speech, unusual behavior and delusional thinking. Real-time polymerase chain reaction amplification of herpes simplex virus type 1 in cerebrospinal fluid was positive (38,000 copies/mL) and antivirus treatment was started. During the course of her illness, the level of her consciousness decreased in association with desaturation and tachycardia. Thrombosis of the right pulmonary artery trunk with pulmonary embolism was evident on enhanced chest computed tomography. In addition, cranial computed tomography revealed subarachnoid and intraventricular bleeding. Intravenous heparin (12,000 U/day) was started and the dose was adjusted according to the activated partial thromboplastin time for about a month (maximum dose of heparin, 20,400 U/day). After the treatments, her Glasgow coma score increased and the thrombosis of the pulmonary artery trunk had disappeared.ConclusionsThe present case raises the question of whether anticoagulant treatment is safe in patients with herpes simplex virus encephalitis complicated by subarachnoid bleeding.

show abstract

“…30 The development of ICH in HSE is not likely to be related to acyclovir administration because patients who were successfully treated for HSE can also develop ICH. 5,7 This suggests that the occurrence of ICH is unrelated to the lytic effects of the virus. It is possible that the host inflammatory response is responsible for the development of ICH.…”

Section: Discussionmentioning

confidence: 99%

Acute Intracranial Hematoma in Herpes Simplex Encephalitis

Anand¹,

Crusio²,

Tarkovsky³

et al. 2010

Infectious Diseases in Clinical Practice

View full text Add to dashboard Cite

Herpes simplex virus is the most common cause of sporadic encephalitis. However, the diagnosis can be challenging in atypical cases. Without prompt treatment, the morbidity and mortality is high. We report a case of herpes simplex encephalitis (HSE) in a 23-year-old man presenting with an intracerebral hematoma. After an anatomical etiology was ruled out, acyclovir was started. Later, polymerase chain reaction of the cerebrospinal fluid was positive for herpes simplex virus-1. We review previously reported cases of HSE with ICH, as well as other atypical presentations of HSE.(Infect Dis Clin Pract 2010;18: 67Y70) H erpes simplex virus (HSV) is the most common cause of sporadic encephalitis in humans. 1,2 Unlike other viruses, HSV often localizes asymmetrically to the orbito-frontal and temporal regions. The brain lesions evolve as acute inflammation leading to a focal, microscopic necrotic hemorrhage. 3,4 Herpes simplex encephalitis (HSE) can rarely be complicated by an intracerebral hematoma (ICH). 5Y14 We describe a case of HSE which presented with an ICH. CASE REPORTA 23-year-old man, with no significant medical history, presented to the emergency department with a headache and subjective fever. The patient was a native of Ukraine who had immigrated to the United States 6 months ago. Seven days before admission, he developed a frontal headache, which was 3 to 4/10 in severity and intermittent in nature. Subsequently, the headache became continuous and gradually increased in severity. Two days after the onset of the headache, he developed subjective fevers. There was no history of recent travel or illness, pets at home, or sick contacts. He denied smoking, use of medications or illicit drugs, and high-risk sexual behavior. He is single and heterosexual.At presentation, the patient was lethargic, but oriented to time, place, and person. His vital signs were as follows: temperature, 102.2-F (rectal); pulse rate, 50 bpm, respiratory rate 16/min; blood pressure, 108/66 mm Hg. No lympadenopathy, organomegaly, rashes, or skin lesions were found. Neurological examination showed normal reflexes, motor, and sensory function. There were no signs of cerebellar dysfunction. Laboratory results are given in Table 1. A computed tomographic (CT) scan of the brain without contrast showed a 2.2 Â 1.2 cm acute ICH in the medial right temporal lobe, intraventricular hemorrhage, and a 2-mm midline shift to the left. A subsequent cranial magnetic resonance imaging (MRI) scan confirmed the above findings (Fig. 1). In addition, it revealed T2-weighted hyperintensity in the cortical and subcortical regions of the right frontal and temporal lobes consistent with an acute hemorrhagic infarct in the distribution of the middle cerebral artery.A cerebral angiogram did not show an aneurysm or an arterio-venous malformation. A lumbar puncture revealed 127 mg/dL of protein, 51 mg/dL of glucose, 1653 red blood cells, and 52 leukocytes, with 96% lymphocytes. Intravenous acyclovir at 600 mg Q8H was started within 24 hours of presentation, and ph...

show abstract

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

Cited by 15 publications

References 11 publications

Case report: Benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression

Case report: Benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression

A successfully treated case of herpes simplex encephalitis complicated by subarachnoid bleeding: a case report

Acute Intracranial Hematoma in Herpes Simplex Encephalitis

Contact Info

Product

Resources

About