Decompressive Craniectomy for Intracerebral Hemorrhage Complicating Herpetic Meningoencephalitis: A Case Report

Main Article Content

Meryem Rafya Yassine Bou-ouhrich Mustapha Ezahiri Rim Echchafi Fatima Zahra Ouamer Boubaker Charra

Abstract

Herpetic encephalitis is the most common viral encephalitis in adults and is the most severe form of   herpes simplex virus infection. The diagnosis is based on polymerase chain reaction in cerebrospinal fluid, as well as brain magnetic resonance imaging. Although intra cerebral petechial hemorrhage has been described during herpetic encephalitis, intraparenchymal cerebral hematoma is an extremely rare form.


The absence of response to treatment or the worsening of clinical symptoms should suspect the diagnosis. The medical treatment is based on acyclovir which should be initiated as soon as the diagnosis is suspected. Surgical treatment is based on decompressive craniotomy.


Herein, we report the case of a 62-year-old man in whom the diagnosis of herpetic encephalitis was confirmed, and the patient was put on acyclovir-based medical treatment. The follow-up was marked by the appearance of an intra-parenchymal hematoma for which the patient had a decompressive craniotomy. The evolution was marked by neurological worsening leading to the death of the patient.

Keywords: Herpetic meningoencephalitis, Intracerebral hemorrhage, Craniectomy, Intensive care

Article Details

How to Cite
RAFYA, Meryem et al. Decompressive Craniectomy for Intracerebral Hemorrhage Complicating Herpetic Meningoencephalitis: A Case Report. Medical Research Archives, [S.l.], v. 11, n. 7.2, july 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4267>. Date accessed: 23 nov. 2024. doi: https://doi.org/10.18103/mra.v11i7.2.4267.
Section
Case Reports

References

1- Smith MG, Lennette EH, Reames HR. Isolation of the virus of herpes simplex and the demonstration of intranuclear inclusions in a case of acute encephalitis. Am J Pathol 1941; 17(1):55-68 1.
2- Tattevin P. Méningoencéphalites infectieuses de l’adulte non immunodéprimé. 2009;30(2):125-134. doi: https://doi.org/10.1016/j.revmed.2008.05.021.
3- Riancho J, Delgado-Alvarado M, Sedano MJ, Polo JM, Berciano J. Herpes simplex encephalitis: clinical presentation, neurological sequelae and new prognostic factors. Ten years of experience. Neurological Sciences. 2013;34(10):1879-1881. doi: https://doi.org/10.1007/s10072-013-1475-9.
4- Sili U, Kaya A, Mert A. Herpes simplex virus encephalitis: Clinical manifestations, diagnosis and outcome in 106 adult patients. Journal of Clinical Virology. 2014;60(2):112-118. doi: https://doi.org/10.1016/j.jcv.2014.03.010.
5- Berger JR, Houff S. Neurological Complications of Herpes Simplex Virus Type 2 Infection. Archives of Neurology. 2008;65(5). doi: https://doi.org/10.1001/archneur.65.5.596.
6- STAHL JP, MAILLES A, De BROUCKER T. Herpes simplex encephalitis and management of acyclovir in encephalitis patients in France. Epidemiology and Infection. 2011;140(2):372-381. doi: https://doi.org/10.1017/s0950268811000483.
7- Alain Jouffroy, F.-X. Desrousseaux, Juret A, A Mohebi, Harboun M. Une méningo-encéphalite herpétique à Herpès Simplex Virus de type 2 chez une patiente de 91 ans. Published online October 1, 2018. doi: https://doi.org/10.1016/j.npg.2018.02.005.
8- Takeuchi S, Takasato Y. Herpes simplex virus encephalitis complicated by intracerebral hematoma. Neurology India. 2011;59(4):594. doi: https://doi.org/10.4103/0028-3886.84344.
9- Roach MR, Drake CG. Ruptured Cerebral Aneurysms Caused by Micro-Organisms. New England Journal of Medicine. 1965;273(5):240-244. doi: https://doi.org/10.1056/nejm196507292730503.
10- Pfister HW ., Borasio GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42(8):1497-1497. doi: https://doi.org/10.1212/wnl.42.8.1497.
11- Haring HP. Time Course of Cerebral Blood Flow Velocity in Central Nervous System Infections. Archives of Neurology. 1993;50(1):98. doi: https://doi.org/10.1001/archneur.1993.00540010092024.
12- Kamboj J, Wu F, Kamboj R, Suzue K, Khosla P. A rare case of acyclovir-induced thrombocytopenia. Am J Ther. 2014;2
13- Tsappa I, Missouris CG, S. Psarellis. Acyclovir-induced thrombocytopaenia in a patient with SLE. Published online June 8, 2018:bcr-225118. doi: https://doi.org/10.1136/bcr-2018-225118.
14- Deigendesch N, Stenzel W. Acute and chronic viral infections. Handbook of Clinical Neurology. Published online 2018:227-243. doi: https://doi.org/10.1016/b978-0-12-802395-2.00017-1.
15- Bradshaw MJ, Venkatesan A. Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management. Neurotherapeutics. 2016;13(3):493-508. doi: https://doi.org/10.1007/s13311-016-0433-7.
16- Modi S, Mahajan A, Dharaiya D, Varelas P, Mitsias P. Burden of herpes simplex virus encephalitis in the United States. Journal of Neurology. 2017;264(6):1204-1208. doi: https://doi.org/10.1007/s00415-017-8516-x.
17- Khan AA, Talib A, Murtaza G. Intracerebral hemorrhages as an atypical radiographic presentation of herpes simplex encephalitis on CT scan: An analysis of 23 patients. Pak JMed Sci2012;28(3):441-444.
18- Ramos-Estebanez C, Lizarraga KJ, Merenda A. A systematic review on the role of adjunctive corticosteroids in herpes simplex virus encephalitis: is timing critical for safety and efficacy? Antiviral Therapy. 2013;19(2):133-139. doi: https://doi.org/10.3851/imp2683.
19- Rodriguez-Sainz A, Escalza-Cortina I, L Guio-Carrión, et al. Intracerebral hematoma complicating herpes simplex encephalitis. 2013;115(10):2041-2045. doi: https://doi.org/10.1016/j.clineuro.2013.06.016.
20- Jouan Y, Grammatico-Guillon L, Espitalier F, Cazals X, François P, Guillon A. Long-term outcome of severe herpes simplex encephalitis: a population-based observational study. Critical Care. 2015;19(1). doi: https://doi.org/10.1186/s13054-015-1046-y.