Xuất huyết não trên bệnh nhân viêm não do Herpes simplex

Herpes Simplex Virus Type 1 (HSV-1) encephalitis stands as a significant global cause of infectious neurological disease, frequently presenting with acute symptoms such as fever, headache, seizures, and altered consciousness. While HSV-1 invades the central nervous system, leading to brain parenchyma necrosis, the occurrence of cerebral hemorrhage as a complication is exceedingly rare. This rarity, coupled with the profound impact cerebral hemorrhage can have on disease progression, underscores the diagnostic and management challenges. This paper aims to highlight this critical issue by presenting a unique case of HSV-1 encephalitis that initially manifested with cerebral hemorrhage, emphasizing the need for heightened clinical awareness.

Neurologists, infectious disease specialists, emergency physicians, pediatricians, and general practitioners interested in neurological complications of viral infections.

Herpes Simplex Virus Type 1 (HSV-1) encephalitis is a prevalent form of sporadic encephalitis worldwide, with variable mortality and significant neurological sequelae despite antiviral treatment. This paper presents the case of a 15-year-old male who initially presented with symptoms atypical for HSV-1 encephalitis, including headache and communication difficulties, without fever. Despite initial improvement following acyclovir treatment and confirmed HSV-1 infection via CSF PCR, the patient's condition rapidly deteriorated on day five, marked by recurrent fever and reduced consciousness. Subsequent diagnostic imaging on day eight revealed a significant cerebral hemorrhage in the left temporal lobe, a complication that is extremely rare in the context of herpes simplex encephalitis and was not observed in the initial MRI. The patient's eventual recovery without surgical intervention, followed by a two-month symptom-free period, highlights the importance of vigilant monitoring. The discussion emphasizes that cerebral hemorrhage can significantly complicate the clinical course of HSV encephalitis, posing diagnostic dilemmas due to overlapping symptoms with the primary infection itself. The underlying mechanisms, possibly involving inflammation-mediated blood-brain barrier disruption or direct viral effects, remain unclear. The case underscores the critical need for early and repeated neuroimaging, such as CT or MRI, in HSV encephalitis patients experiencing an unexpected worsening of clinical status, even when on appropriate antiviral therapy, to promptly identify and manage acute complications like cerebral hemorrhage.