Intracerebral hematoma complicating herpes simplex encephalitis

Herpes Simplex Encephalitis Complicated by Cerebral Hemorrhage during Acyclovir Therapy

“…First, the site of hemorrhage was consistent with the region in which HSE-associated inflammation was observed. Second, the timing of the onset of hemorrhage was typical for HSE-related cerebral hemorrhage (4). Although the precise cause of cerebral hemorrhage in HSE patients remains unclear, based on the pathological findings in similar cases, we hypothesize that the rupture of the small vasculitic vessels of the brain due to HSV-induced inflammation was a possible mechanism of our patient's bleeding (5,6).…”

“…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.…”

“…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.…”

“…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.…”

Bilateral Cerebral Hemorrhage in Herpes Simplex Encephalitis: Rare Occurrence

“…[7,8] Similarly, Li and Sax, Fukushima et al, Takeuchi and Takasato, and Rodríguez-Sainz et al reported patients with HSE who developed temporal lobe hematoma as late complication. [3,[9][10][11] The presenting manifestation of the patient reported by Yu et al was temporal lobe hematoma without preceding fever. [12] The intracerebral hematoma in the above-mentioned case reports involved the temporal lobe which is the typical area affected by the HSV.…”