Korean J Clin Neurophysiol.  2015 Dec;17(2):82-85. 10.14253/kjcn.2015.17.2.82.

Asymptomatic Hematoma in Herpes Simplex Encephalitis

• Song SJ
• Na BS
• Song JM
• Woo HG
• Lee D
• Ahn TB

• KMID: 2403245
• DOI: http://doi.org/10.14253/kjcn.2015.17.2.82

Abstract

A 59-year old man was admitted for drowsiness and stiff neck. CSF examination showed lymphocytic pleocytosis and PCR for herpes simplex virus (HSV)-1 was positive in CSF. Brain MRI revealed enhanced lesions in left temporal lobe. His symptom improved with acyclovir. Follow-up studies showed red blood cells in CSF and a hematoma in the left temporal lobe. There was no additional symptom related to the hematoma. He was discharged after conservative care. Although rare, hematoma can develop in HSV-1 meningoencephalitis.

Keyword

Herpes simplex virus; Meningoencephalitis; Acyclovir; Hematoma

MeSH Terms

Acyclovir
Brain
Encephalitis, Herpes Simplex*
Erythrocytes
Follow-Up Studies
Hematoma*
Herpes Simplex*
Herpesvirus 1, Human
Leukocytosis
Magnetic Resonance Imaging
Meningoencephalitis
Neck
Polymerase Chain Reaction
Simplexvirus
Sleep Stages
Temporal Lobe
Acyclovir

Figure

• 

  Fig. 1. Brain magnetic resonance imaging (MRI). Fluid attenuated inversion recovery MRI shows high signal intensity in the left medial temporal lobe area, which is enhanced by gadolinium on T1 weighted imaging (A, B). Gradient echo imaging shows no hemorrhage, and magnetic resonance angiography is normal (C, D).

• 

  Fig. 2. Brain computed tomography (CT). CT shows a large hematoma in the left medial temporal lobe (A), which shrinks in the follow-up study (B).

Reference

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