Abstract
Herpes Simplex encephalitis is eminently treatable viral encephalitis which can rarely be complicated by a tumefactive inflammatory focus. The treatment strategy in this event should be aggressive to prevent immediate fatality as well as long term sequele. A 43-year-old woman with HSE developed new onset focal deficit with altered sensorium on the fourth day of illness despite early initiation of antiviral treatment. Imaging revealed right temporal and insular involvement with mass effect and midline shift. Decompressive craniectomy and temporal lobe biopsy was performed on emergent basis. The patient made remarkable clinical recovery subsequently. The report is presented for highlighting this rare complication as well as to reinstate the belief in surgical decompression as the preferred choice of treatment.
Highlights
Herpes simplex encephalitis is the one of the most common form of viral encephalitis across all races and age groups
A 43-year-old housewife hailing from a rural district in Southern India was apparently well four days back when she developed high grade fever accompanied by altered sensorium 12-14 hours into the illness
Neurological manifestations occur after a viral prodrome in the form of altered sensorium, headache, seizures and or focal neurological deficits
Summary
Herpes simplex encephalitis is the one of the most common form of viral encephalitis across all races and age groups. Complications like non-convulsive status epilepticus and raised intracranial pressure can claim lives in a proportion of cases especially in a setting where scrupulous monitoring of patients are not performed. We report an illustrative case where timely surgical intervention was associated with excellent clinical outcome.
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