A review of the combined medical and surgical management in patients with herpes simplex encephalitis

Safain, Mina G.; Roguski, Marie; Kryzanski, James; Weller, Simcha J.

doi:10.1016/j.clineuro.2014.10.015

Cited by 31 publications

(31 citation statements)

References 40 publications

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“…In severe cases of cerebral edema refractory to the aforementioned medical management, barbiturate coma and/or decompressive craniectomy should be considered. Case series and case reports suggest the potential for good outcomes, even in cases of bacterial meningitis or viral encephalitis requiring surgical intervention [139]. Patients with evidence of obstructive hydrocephalus should likewise be evaluated for surgical intervention such as external ventricular drainage.…”

Section: Edema and Herniationmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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Section: Edema and Herniationmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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“…In addition to cerebral hemorrhage (4), seizures (2,3), increased intracranial pressure (3,7-10), stroke (11,12), subarachnoid hemorrhage (13), and central diabetes insipidus (14) have been reported as complications during the acute phase of HSE (this includes the period of acyclovir therapy). The list of reported complications is shown in Table.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral hemorrhage and increased intracranial pressure have mostly been observed during acyclovir therapy, within 2 weeks after admission (3,4,7-10); the condition of patients may decline in this period due to HSE and not because of complications, which can pose a challenge for the differential diagnosis. Furthermore, the symptoms of these two complications, which include deteriorated consciousness, headache, hemiparesis, hemiplegia, and third nerve palsy, are similar to those of HSE (3,4,7-10). Thus, the possibility of a diagnostic delay may be higher in patients with cerebral hemorrhage and increased intracranial hypertension than in those with other complications.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the possibility of a diagnostic delay may be higher in patients with cerebral hemorrhage and increased intracranial hypertension than in those with other complications. However, these two complications frequently require surgical intervention (3,4,7-10). Because both complications can be detected by computed tomography (as in our case), clinicians should consider repeat computed tomography to allow for the early detection of these potential complications in patients who display a worsening clinical condition despite the administration of acyclovir treatment.…”

Section: Discussionmentioning

confidence: 99%

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Herpes Simplex Encephalitis Complicated by Cerebral Hemorrhage during Acyclovir Therapy

Harada

Hara

2017

Intern. Med.

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Herpes simplex encephalitis (HSE) can be complicated by adverse events in the acute phase. We herein present the case of a 71-year-old woman with HSE complicated by cerebral hemorrhage. She presented with acute deterioration of consciousness and fever and was diagnosed with HSE based on the detection of herpes simplex virus-1 in the cerebrospinal fluid by a polymerase chain reaction. The cerebral hemorrhage developed during acyclovir therapy; however, its diagnosis was delayed for 2 days. After the conservative treatment of the cerebral hemorrhage, the patient made a near-complete recovery. Cerebral hemorrhage should be considered as an acute-phase complication of HSE.

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“…Intensive care, antiviral drugs, corticosteroids, hyperosmolar therapy and hyperventilation are sufficient for the resolution of edema in most patients, with rare cases in which surgical intervention to reduce the intracranial pressure becomes necessary. [1][2][3][4] To date, the literature shows some reports of isolated cases, with a good evolution of the patients after the decompression procedure.…”

Section: Introductionmentioning

confidence: 99%

Decompressive Craniectomy for Viral Encephalitis: Two Case Reports

Caramanti¹,

Abib²,

Moraes

et al. 2016

Arq Bras Neurocir

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A decompressive craniectomy is a therapeutic modality not commonly used in cases of refractory intracranial hypertension due to viral encephalitis. In this article the authors present two cases of patients with viral encephalitis that have undergone decompressive craniectomy to control intracranial pressure. Both evolved with Glasgow outcome score of 4. The main clinical data for the surgical decision are Glasgow coma scale and the pupils of the patient associated with the imaging tests showing a large necrotic area and perilesional edema. The evolution of the patients undergoing decompression was satisfactory in 92.3% of cases.

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A review of the combined medical and surgical management in patients with herpes simplex encephalitis

Cited by 31 publications

References 40 publications

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Encephalitis Complicated by Cerebral Hemorrhage during Acyclovir Therapy

Decompressive Craniectomy for Viral Encephalitis: Two Case Reports

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