Sudden ‘Stroke-Like’ Onset of Hemiparesis Due to Herpetic Encephalitis

Abduljabbar, Mohammad; Ghozi, Ibrahim; Haq, Anwar Ul; Korner, Hanz

doi:10.1017/s0317167100039573

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…Although unusual, a sudden stroke-like onset without encephalitic features has been previously reported by Abdul-Jabbar et al 5 in an immuno-competent patient. There had been no fever on admission and serum sodium concentration was normal.…”

Section: Discussionsupporting

confidence: 57%

Viral encephalitis and atherothrombotic stroke

2012

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SummaryThe clinical hallmark of viral encephalitis is an acute febrile illness, but stroke-like presentations have been rarely described. We report a patient who arrived at A&E with an acute right middle cerebral artery syndrome, without fever. Following thrombolytic treatment, clinical deficit almost disappeared and a critical ipsilateral carotid stenosis was identified. Stenting was implemented and 7 days later the patient started with high fever and reappearance of the initial deficit. Hyperperfusion syndrome and pneumonia were initially considered as the diagnosis but herpetic encephalitis (HE) was the final diagnosis. A very good response to antiviral treatment was achieved. We discuss whether the patient suffered from an unusual sudden stroke-like onset HE without encephalitic features or whether a stroke led to delayed HE. BACKGROUND

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Section: Discussionsupporting

confidence: 57%

Viral encephalitis and atherothrombotic stroke

2012

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“…Similar to our patient, her diagnosis was based on MRI and positive titers of antibodies against herpes simplex type one in CSF analysis. This puts it in the differential diagnosis of acute stroke in young patients, even in the absence of encephalitic features, and also emphasizes that early MRI examination could be of great help in delineating the pathology at presentation [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Herpes Simplex Virus Encephalitis: Atypical Presentation as a Right Middle Cerebral Artery Stroke

Shoaib

Kraus

Khan

2018

Cureus

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Herpes simplex virus encephalitis (HSVE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis.We report a case of HSVE presenting as a stroke mimic in a 76-year-old female with a history of atrial fibrillation on warfarin. She was admitted to our medical intensive care unit with intermittent fever, lethargy, and new onset left-sided hemiparesis. A computed tomography (CT) of the head showed a right middle cerebral artery (MCA) acute ischemic stroke with midline shift and a dense right MCA sign. Brain magnetic resonance imaging (MRI) showed evidence of acute stroke with consideration of herpes encephalitis. CSF analysis was positive for herpes simplex virus (HSV) type one. She recovered with high-dose intravenous acyclovir therapy.Our patient was a diagnostic dilemma, initially being diagnosed with an acute ischemic stroke and yet found to have HSVE, which mimicked an acute ischemic stroke. Delay in treatment may result in devastating clinical outcomes that may include severe cognitive, focal neurological deficits, persistent seizures, and even death. This case highlights the importance of a multidisciplinary approach and the need for increased awareness of an atypical presentation of HSVE among emergency physicians, neurologist, intensivists, and radiologists.

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“…Similar to our patient, her diagnosis was based on MRI and positive titers of antibodies against herpes simplex type one in CSF analysis. This puts it in the differential diagnosis of acute stroke in young patients, even in the absence of encephalitic features, and emphasizes that early MRI examination could be of great help in delineating the pathology at presentation [4].…”

Section: Discussionmentioning

confidence: 98%

Generalized Epilepsy with Right Hemiparesis Secondary to Herpes Encephalitis

Lwin

Naing

Soe

et al. 2020

IJMPCR

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Herpes simplex encephalitis (HSE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis. A 7-year-old Malay girl with known case of right hemiplegia secondary to herpes encephalitis presented to the neuropediatric ward, in General Hospital with refractory seizure. She had a moderate learning disability and diagnosed as right hemiparesis secondary to herpes encephalitis complicated with epilepsy. She was planned for the positron emission tomography (PET) scan and to undergo operation if PET scan was feasible (Hemispherectomy). However, the patient refused for operation. Prompt clinical recognition is important in the HSE to prevent progressive brain tissue damage, haemorrhagic changes, and worsening of the encephalitis. Diagnosis is usually confirmed through an extensive evaluation, including a thorough clinical examination with attention to findings on mental status changes, cerebrospinal fluid (CSF) analysis, electroencephalogram (EEG) testing and findings on neuroimaging. Once HSE is suspected, high-dose acyclovir should be started immediately before lumbar puncture (LP), and only stopped once a definitive alternate diagnosis has been established. This case is reported because the patient has generalized epilepsy with right hemiparesis secondary to herpes encephalitis. Herpes encephalitis with right hemiparesis cases are quite rare.

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Sudden ‘Stroke-Like’ Onset of Hemiparesis Due to Herpetic Encephalitis

Cited by 7 publications

References 9 publications

Viral encephalitis and atherothrombotic stroke

Viral encephalitis and atherothrombotic stroke

Herpes Simplex Virus Encephalitis: Atypical Presentation as a Right Middle Cerebral Artery Stroke

Generalized Epilepsy with Right Hemiparesis Secondary to Herpes Encephalitis

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