Herpes simplex 1 encephalitis presenting as a brain haemorrhage with normal cerebrospinal fluid analysis: a case report
Herpes simplex 1 encephalitis presenting as a brain haemorrhage with normal cerebrospinal fluid analysis: a case report
Introduction:
Herpes simplex encephalitis is a potentially lethal infection that should be recognised as soon as possible. The combination of clinical history and examination, brain computed tomography or magnetic resonance imaging and lumbar puncture has been used to establish a diagnosis.
Case presentation:
We present a patient who had a suggestive history but a totally normal lumbar puncture and only evidence of intracerebral haemorrhage in the brain magnetic resonance imaging. Diagnosis was made by using the cerebrospinal fluid polymerase chain reaction for herpes simplex virus.
Conclusion:
Herpes simplex encephalitis is being increasingly diagnosed with the availability of new diagnostic techniques. Herpes simplex encephalitis can present with the combination of haemorrhage and normal cerebrospinal fluid. Awareness of this common but, if left untreated,devastating condition should increase.
Introduction
The rapid diagnosis of central nervous system infection with herpes simplex virus (HSV) is important because of the potential morbidity and mortality associated with the disease as well as the wide availability of acyclovir which has been proven to ameliorate the symptoms. Left untreated, more than 70% of cases of HSV encephalitis (HSVE) are fatal and only approximately 11% of patients recover normal premorbid function [1,2]. Treatment with acyclovir has been proven to reduce mortality to approximately 20% [3,4]. So far, the diagnosis of HSVE has relied on the combination of a compatible clinical scenario, a suggestive brain computed tomography (CT) scan or brain magnetic resonance imaging (MRI) and the examination of the cerebrospinal fluid (CSF) by microscopy, biochemical analysis and polymerase chain reaction (PCR) for the presence of HSV DNA. HSVE has been left undiagnosed in the past, resulting in the patient's demise because of the lack of CSF pleocytosis, a normal CT and the absence of focal features on neurological examination [5].
Herpes simplex 1, encephalitis, brain haemorrhage, cerebrospinal fluid analysis, Herpes,
- Boston Interhospital Virus Study Group, NIAID-Sponsored Cooperative Antiviral Clinical Study: Failure of high dose 5-iodo-2'-deoxyuridine in the therapy of herpes simplex virus encephalitis: evidence of unacceptable toxicity. N Engl J Med 1975, 292:599-603.
- Whitley RJ, Soong SJ, Dolin R, Galasso GJ, Ch'ien LT, Alford CA: Adenine arabinoside therapy of biopsy-proved herpes simplex encephalitis: National Institute of Allergy and Infectious
