Abstract
A temporal massive hemorrhagic necrosis is an uncommon but known complication of herpes encephalitis. Cerebral vein or sinus thrombosis is a very rare complication of herpes encephalitis. Due to its rarity, this complication can go under-diagnosed, resulting at times in grave neurological deficits for the patient. The concurrent existence of both complications is even less common and difficult to diagnose. This also complicates the medical management of the patient due to contradicting considerations. We report a case of a twenty years old female, admitted with herpes encephalitis. The clinical course was complicated by a right temporal lobe massive hemorrhagic necrosis and a late sigmoid sinus vein thrombosis. Intravenous heparin, administered for the thrombosis resulted in further deterioration with evidence of increased hemorrhagic mass lesions, elevated intracranial pressure, uncal herniation and a right "blown pupil". The patient underwent a decompressive craniectomy with dural fenestrations. The patients quickly recovered, regained consciousness and was weaned off respirator. Anticoagulant therapy was reinstituted within 48 h of surgery with no further complications. We advocate a high index of suspicion (clinical and radiological) for both hemorrhagic and thrombotic complications in herpes encephalitis patients, and a judicious use of anticoagulation. A multidisciplinary team approach and an early neurosurgical consult in such patients should be the routine. Key words: Temporal, hemorrhagic necrosis, herpes encephalitis, cerebral vein thrombosis, sinus thrombosis.
Highlights
The morbidity and mortality of herpes simplex encephalitis has decreased in past years, with the widespread application of antivirals, the liberal use of imaging, heightened awareness and better patient monitoring
One cause of morbidity is the development of focal hemorrhagic necrosis and edema in the temporal lobes, giving rise to space-occupying lesions, with a subsequent elevation of intracranial pressure. (Gonzalez et al, 2008)
Multivariate negative prognostic signs were age older than 37 years, male sex, coma on admission, cerebral hemorrhage on admission, thrombosis of the deep venous system, central nervous system infection and cancer. Taken this data into account, it seems that patients with herpes encephalitis suffering a temporal lobe hemorrhagic necrosis and concurrent cerebral vein thrombosis (CVT) suffer a grim prognosis due a multitude of etiologies
Summary
A case of surgically treated hemorrhagic herpes encephalitis complicated by a sigmoid sinus vein thrombosis. A temporal massive hemorrhagic necrosis is an uncommon but known complication of herpes encephalitis. Cerebral vein or sinus thrombosis is a very rare complication of herpes encephalitis. The concurrent existence of both complications is even less common and difficult to diagnose. This complicates the medical management of the patient due to contradicting considerations. The clinical course was complicated by a right temporal lobe massive hemorrhagic necrosis and a late sigmoid sinus vein thrombosis. We advocate a high index of suspicion (clinical and radiological) for both hemorrhagic and thrombotic complications in herpes encephalitis patients, and a judicious use of anticoagulation.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
