Intracranial Hemorrhage following Lumbar Puncture in a Patient on Apixaban

Vijapura, Priyanka; Maniaci, Michael J.

doi:10.1159/000502735

Cited by 2 publications

(4 citation statements)

References 13 publications

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“…Lymphocytic pleocytosis can be seen in the CSF and PCR HSV is 95% sensitive and specific at 48 to 72 hours. Without treatment, the mortality from HSV encephalitis can be as high as 70% [1][2][3]. The lumbar puncture was delayed in our patient as he was on apixaban for DVT which needs a washout period after discontinuation for lumbar puncture [3,4].…”

Section: Discussionmentioning

confidence: 84%

“…Without treatment, the mortality from HSV encephalitis can be as high as 70% [1][2][3]. The lumbar puncture was delayed in our patient as he was on apixaban for DVT which needs a washout period after discontinuation for lumbar puncture [3,4]. Treatment with acyclovir has been proven to reduce mortality to approximately 20% [5].…”

Section: Discussionmentioning

confidence: 87%

“…HSV 1 is the most predominant virus identified with the cases of intracerebral hemorrhage, as seen in our patient [3]. On imaging, necrotizing infiltrate with scattered foci of small hemorrhage in the brain is usually seen; but frank hematoma is rare and usually occurs during the second week after initial presentation [5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 92%

“…HSV-1 is associated with significant morbidity and mortality of up to 70% without treatment [1,2]. Treatment with acyclovir has been proven to reduce mortality to approximately 20% [3]. The most common central nervous system complication of HSV encephalitis is seizures (38%), while intracranial hemorrhage is very rare (2.7%) [4].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Case Report of Herpes Simplex-1 Viral Encephalitis Complicated by Hemorrhagic Conversion

Ehret¹,

Safi²,

Akabusi³

et al. 2022

Cureus

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Herpes simplex virus (HSV) encephalitis is the most common cause of nonendemic sporadic encephalitis in the United States. Treatment with acyclovir has been proven to reduce mortality by 50%. Antiviral therapy should be initiated immediately in patients with clinical suspicion of viral encephalitis and should not be delayed by serological confirmation of the diagnosis. The most common central nervous system complication of HSV encephalitis is seizures (38%), while intracranial hemorrhage is very rare (2.7%). We describe a case of a 59-year-old African American male who presented to the hospital after being found unresponsive for a day and was found to have HSV-1 encephalitis that was complicated by hemorrhagic conversion. Our patient's neurological status did not improve even with appropriate antiviral treatment with a 28-day course of intravenous (IV) acyclovir. Intracranial hemorrhage is a rare complication in patients with HSV encephalitis. Close monitoring of neurological status is recommended for signs of deterioration or lack of improvement, and further imagings are needed (as in our patient) to evaluate for neurological complications such as intracranial hemorrhage.

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