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

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.