acyclovir and Cerebral-Hemorrhage

This is a case report of PCR proven herpes simplex (HSV-1) encephalitis in a 26 years old immunocompetent adult taking an unusual course of acute intracerebral haematoma after successful and complete recovery with acyclovir therapy. This transient late complication was associated with a negative repeat CSF PCR for HSV suggesting that the initial 14 days course of acyclovir was successful in the eradication of the herpes virus infection as recommended by the International Herpes Management Forum (IHMF). The location of the haematoma corresponded to the initial encephalitic area involving the medial temporal lobe structures. Despite this late neuroradiologic complication, after day 18 of symptom onset, the patient had a favourable neurological outcome. To the best of our knowledge, this is the second report of the unusual, rare, and late neuroimaging complication of acute intracerebral haematoma formation after complete recovery from treated HSVE with favourable clinical outcome. The literature is reviewed and plausible aetiology is discussed.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Hemorrhage; Encephalitis, Herpes Simplex; Hematoma; Humans; Male; Temporal Lobe

A 72-year-old man was admitted to our hospital because of right facial muscle weakness and diplopia. He had been treated for aplastic anemia with cyclosporin for 2 years. Thirteen days before admission, a diagnosis of herpes zoster was made and treated with amenamevir. On admission, neurological examination revealed mild cognitive disturbance, mydriasis, weakness of the inferior rectus muscle of the left eye, and right peripheral facial nerve palsy. Cerebrospinal fluid (CSF) analysis showed elevated leukocytes and increased protein levels. Antibody index to varicella-zoster virus (VZV) was elevated in CSF to 25.6, although VZV DNA was negative by PCR. Head CT revealed multiple intracerebral hemorrhages in the left dorsal pons, left ventral midbrain, left thalamus, and left front-parietal lobe. MR angiography detected cerebral artery stenosis. In addition to intravenous acyclovir, the patient was treated with steroid pulse therapy and steroid tapering therapy. One month after admission, his symptoms improved. We diagnosed him with VZV vasculopathy. We believe that multiple intracerebral hemorrhages due to VZV vasculopathy caused facial and oculomotor nerve palsy. Our findings suggest that cerebral hemorrhage induced by VZV vasculopathy must be considered when differentiating cranial nerve palsy after herpes zoster.

Topics: Acyclovir; Aged; Brain; Cerebral Hemorrhage; Cranial Nerve Diseases; Diffusion Magnetic Resonance Imaging; Herpesvirus 3, Human; Humans; Magnetic Resonance Angiography; Male; Methylprednisolone; Prednisolone; Pulse Therapy, Drug; Tomography, X-Ray Computed; Treatment Outcome; Varicella Zoster Virus Infection; Vasculitis, Central Nervous System

Herpes simplex encephalitis (HSE) can be complicated by adverse events in the acute phase. We herein present the case of a 71-year-old woman with HSE complicated by cerebral hemorrhage. She presented with acute deterioration of consciousness and fever and was diagnosed with HSE based on the detection of herpes simplex virus-1 in the cerebrospinal fluid by a polymerase chain reaction. The cerebral hemorrhage developed during acyclovir therapy; however, its diagnosis was delayed for 2 days. After the conservative treatment of the cerebral hemorrhage, the patient made a near-complete recovery. Cerebral hemorrhage should be considered as an acute-phase complication of HSE.

Topics: Acyclovir; Aged; Antiviral Agents; Cerebral Hemorrhage; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Fever; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed

Neurologic complications related to Epstein-Barr virus (EBV) in immunocompetent adults are rare and most commonly self-limited. However, severe cases have been previously reported in the literature. We describe a case of meningoencephalitis with frontal bilateral hemorrhage in a non-immunocompromised adult following an EBV infection of the central nervous system confirmed by the presence of EBV-DNA in the cerebrospinal fluid. During the patient's hospital stay, there was a favorable clinical and radiologic evolution and the patient was discharged asymptomatic. To our knowledge, this is the fourth case of hemorrhagic meningoencephalitis related to EBV and the first one in an immunocompetent patient with a favorable outcome.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Cerebral Hemorrhage; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Meningoencephalitis; Middle Aged; Neuroimaging; Treatment Outcome

To describe two patients who developed an intracranial hematoma as a complication of temporal lobe encephalitis due to herpes simplex type 1 virus, and to review the literature.. The first patient, a 45-year-old woman developed a brain hematoma in the location of the encephalitic lesion on day 9 after the onset of herpes simplex encephalitis (HSE) that required surgical evacuation. The second patient, a 53-year-old woman was being treated for HSE; on day 8 after admission a temporal lobe hematoma with midline shift was disclosed due to persistent headache. Both patients survived but were left with sequelae. We conducted a PubMed/MEDLINE search from 1986 to April 2013 on this topic.. We have found 20 additional cases reported in the literature and review their characteristics. Hemorrhage was present on admission in 35% of pooled patients, and consistently involved the area of encephalitis. Clinical presentation of intracranial hemorrhage overlapped the encephalitic symptoms in two-thirds of the patients. Half of patients underwent surgery. Overall, mortality rate was low (5.2%), and half of patients fully recovered.. Intracranial bleeding, although infrequent, can complicate the evolution of herpes simplex encephalitis and should be borne in mind since its presence may require neurosurgery. Although its presentation may overlap the encephalitic features, the lack of improvement or the worsening of initial symptoms, particularly during the second week of admission, should lead to this suspicion and to perform a neuroimaging study.

Topics: Acyclovir; Antiviral Agents; Brain; Cerebral Hemorrhage; Decompressive Craniectomy; Encephalitis, Herpes Simplex; Female; Glasgow Coma Scale; Hematoma; Hepatitis C; Humans; Magnetic Resonance Imaging; Middle Aged; Nervous System Diseases; Neurosurgical Procedures; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acyclovir; Adult; Brain Edema; Cerebral Hemorrhage; Craniotomy; Emergencies; Encephalitis, Herpes Simplex; Fatal Outcome; Female; Hematoma; Hemiplegia; Humans; Magnetic Resonance Imaging; Mydriasis; Respiratory Insufficiency; Temporal Lobe; Tomography, X-Ray Computed

We report a case of a 35-year-old female with herpetic meningoencephalitis confirmed by polymerase chain reaction and immunohistochemical study for herpes simplex virus-1 accompanied with a massive intracerebral hematoma as a complication. A hematoma localized at the medial temporal lobe and the medial frontal lobe occurred on the 11th day after initiation of acyclovir treatment. She subsequently required emergency surgery for temporal lobectomy, as well as hematoma and external decompression. Intracerebral hematoma with MR imaging showed gyral pattern along the cortex of the medial temporal lobe and the base of the medial frontal lobe. We speculate that the hemorrhage occurred by rupture of small vessels affected by vasculitis in addition to hypertension caused by increased intracranial pressure. We therefore emphasize the risk of intracerebral hemorrhage at an early stage or during acyclovir treatment, especially during one or two weeks after initiation of the treatment, and the necessity of careful observation during these periods.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Hemorrhage; Encephalitis, Herpes Simplex; Female; Frontal Lobe; Hematoma; Humans; Temporal Lobe

Although herpes simplex virus type 1 (HSV-1) is the most common cause of sporadic encephalitis in immunocompetent adults, it is an unusual cause of encephalitis in patients with HIV/AIDS. We report the case of a 56-year-old man with recently diagnosed HIV infection who presented with subacute mental status changes, fever, and temporal lobe abnormalities evident on brain imaging. Results of a polymerase chain reaction assay of the cerebrospinal fluid were positive for HSV-1. His course was complicated by 2 episodes of cerebral hemorrhage. He ultimately improved after surgical decompression, treatment with acyclovir, and a switch from a protease inhibitor-based antiretroviral regimen to one including an integrase inhibitor.

Topics: Acyclovir; Antiviral Agents; Cerebral Hemorrhage; Encephalitis, Herpes Simplex; Herpesvirus 1, Human; HIV Infections; Humans; Infusions, Intravenous; Male; Memory Disorders; Middle Aged; Seizures; Tomography, X-Ray Computed

Acute hemorrhagic leukoencephalitis (AHL) is a rare and usually fatal disorder characterized by an acute onset of neurological abnormalities. It may occur in association with a viral illness or vaccination. Radiology and brain biopsy are essential for the diagnosis. We present a case of AHL mimicking or manifesting as intracerebral hemorrhage associated with herpes simplex virus. A 3-year-old boy was admitted to our hospital with cerebral hemorrhage. The findings of cerebrospinal fluid, MRI and electroencephalogram indicated acute hemorrhagic leukoencephalitis associated with herpes simplex virus involving the left parietal cortex (hemorrhage) and the right temporal lobe (encephalitis). The patient received intravenous dexamethasone (1.5 mg/kg/24 h divided q6 (six times a day) for 5 days, tapered slowly to discontinuation over the next 5 days) and aciclovir (15 mg/kg/every 6 h for 14 days). His clinical condition markedly improved, and after 3 weeks he was discharged from the hospital with moderate right hemiparesis. Mild hemiparesis with normal psychometric testing was determined when he was checked 6 months later. AHL remains misdiagnosed as viral encephalitis because it produces different protean clinical forms. Pediatric patients admitted with cerebral hemorrhage and infarct should be evaluated for presence of hemorrhagic encephalitis-causing agents, especially for herpes simplex. Since, as in our case, treatment with corticosteroid and acyclovir markedly improves conditions of herpes simplex-caused AHL, we suggest that early diagnosis and treatment is of importance for the prognosis.

Topics: Acyclovir; Antiviral Agents; Cerebral Hemorrhage; Child, Preschool; Diagnostic Errors; Herpes Simplex; Herpesvirus 1, Human; Humans; Leukoencephalitis, Acute Hemorrhagic; Male

We describe a 14-month-old patient with atypical presentation of herpes simplex encephalitis. She initially presented with fever, lethargy, seizures, and large hemorrhages in the right parietal lobe, and clinical findings suggestive of a hypercoagulable state. The etiology of coagulation abnormality was not identified, although it was suggested as a possible causative factor in severe bleeding along with acute neuronal lysis as a result of infection. Although large intracerebral hemorrhages are occasionally described with systemic herpes infection, this presentation is unusual beyond the infant period.

Topics: Acyclovir; Adolescent; Blood Coagulation Tests; Cerebral Cortex; Cerebral Hemorrhage; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Magnetic Resonance Imaging; Neurologic Examination; Polymerase Chain Reaction; Pregnancy; Tomography, X-Ray Computed