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

Elshimy, Ghada; Joy, Christina Mariyam; Berlin, Fred S.; Lashin, Waleed

doi:10.1155/2017/6038146

Cited by 13 publications

(14 citation statements)

References 26 publications

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“… Mild improvement of cortical blindness (4) 23 (2016), Fisahn C [ 38 ] 69, f HSV*, brain biopsy, not reported Stroke-like (acute onset of headache and right hemiparesis) No loco-typico lesions Left parietal lobe, hematoma, subarachnoid hemorrhage Day 1, on first imaging n.e. Died (6) 24 (2017), Mueller K [ 39 ] 40, f HSV-2, PCR, 558 cells/μl Unspecific (headache, fever, nausea, vomiting) CT on first day normal Right temporal lobe, hemorrhage, midline shift Day 7, day 14 No, hemicraniectomy and temporal lobectomy Survived, no further details reported 25 (2017), El Shimy G [ 40 ] 49, m PCR negative, 45 cells/μl Encephalitis (fever, headache, altered mental status) Right temporal lobe and insula Right medial temporal lobe, hematoma Day 2, day 14 No Returned to baseline neurological status (0) 26 (2013), Lo WB [ 41 ] 46, m HSV-1, PCR, 390 cells/μl Encephalitis (fever, headache, confusion) Left temporal lobe Left temporal lobe, hematoma, edema, uncal herniation Day 7, day 10 Craniotomy on day 6, removal of anterior temporal lobe and evacuation of hematoma Gradual improvement, no further details reported 27 (2018), Sivasankar C [ 42 ] 71, f HSV-1, IHC, n.e. Encephalitis (decreased responsiveness, hemiparesis, seizure) Both temporal and parietal lobes Right temporal lobe, hematoma, edema, uncal herniation Day 1, day 8 (postoperative) No, craniotomy for evacuation of hematoma on day 8 Died on day 17 after hospital admission (6) *PCR methodology did not distinguish between HSV-1 and HSV-2.…”

Section: Resultsmentioning

confidence: 99%

Cerebrovascular manifestations of herpes simplex virus infection of the central nervous system: a systematic review

Hauer

Pikija

Schulte

et al. 2019

J Neuroinflammation

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BackgroundIntracerebral hemorrhage and ischemic stroke are increasingly recognized complications of central nervous system (CNS) infection by herpes simplex virus (HSV).Aim of the studyTo analyze clinical, imaging, and laboratory findings and outcomes of cerebrovascular manifestations of HSV infection.MethodsSystematic literature review from January 2000 to July 2018.ResultsWe identified 38 patients (median age 45 years, range 1–73) comprising 27 cases of intracerebral hemorrhage, 10 of ischemic stroke, and 1 with cerebral venous sinus thrombosis. Intracerebral hemorrhage was predominantly (89%) a complication of HSV encephalitis located in the temporal lobe. Hematoma was present on the first brain imaging in 32%, and hematoma evacuation was performed in 30% of these cases. Infarction was frequently multifocal, and at times preceded by hemorrhage (20%). Both a stroke-like presentation and presence of HSV encephalitis in a typical location were rare (25% and 10%, respectively). There was evidence of cerebral vasculitis in 63%, which was exclusively located in large-sized vessels. Overall mortality was 21% for hemorrhage and 0% for infarction. HSV-1 was a major cause of hemorrhagic complications, whereas HSV-2 was the most prevalent agent in the ischemic manifestations.ConclusionWe found a distinct pathogenesis, cause, and outcome for HSV-related cerebral hemorrhage and infarction. Vessel disruption within a temporal lobe lesion caused by HSV-1 is the presumed mechanism for hemorrhage, which may potentially have a fatal outcome. Brain ischemia is mostly related to multifocal cerebral large vessel vasculitis associated with HSV-2, where the outcome is more favorable.

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Section: Resultsmentioning

confidence: 99%

Cerebrovascular manifestations of herpes simplex virus infection of the central nervous system: a systematic review

Hauer

Pikija

Schulte

et al. 2019

J Neuroinflammation

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“…Indeed, SARS-CoV-2 shares similar characteristics with SARS-CoV, and both anecdotal and statistical data indicate that neurologic symptoms are not common in COVID-19 patients [10]. Since it is well known that cerebral hemorrhage may result from viral infection of the CNS compromising the neurovascular unit [37][38][39][40], available evidence strongly suggest that SARS-CoV-2 infection may greatly increase the incidence of hemorrhagic stroke, especially in at-risk patients.…”

Section: Potential Impact Of Covid-19 On Hemorrhagic Stroke In the Elmentioning

confidence: 99%

Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients

Wang

Tang

Fan

et al. 2020

Aging

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has been recognized as a new human disease [1]. The causative agent was identified as a novel coronavirus strain, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the Coronavirus Study Group (CSG) [2]. The mortality rate of SARS-CoV-2 is lower than those of Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) [3]. However, SARS-CoV-2 spreads more rapidly than MERS-CoV and SARS-CoV because viral load and infectiousness peak before or around the time of symptom onset, i.e. much earlier than for both MERS-CoV and SARS-CoV [3]. The high transmissibility of SARS-CoV-2 is denoted by a basic reproduction number (R0) of 3.39 over the whole epidemic period [4]. Moreover, COVID-19 can be transmitted by asymptomatic carriers during the incubation period [4-7], probably because they carry viral loads similar to those of symptomatic patients [8]. Although further studies are warranted to ascertain the epidemiological significance of www.aging-us.com

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“…Vasculitis or transient hypertension caused by increased ICP plays a major role in having lobar hemorrage. The hypothesis include the rupture of the small vessels due to these above causes (11). Magnetic resonance imaging (MRI ) of the brain is the preferred imaging study; T2 images may be more helpful than T1 images (12).…”

Section: Discussionmentioning

confidence: 99%