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Neurological picture
Herpes encephalitis complicated by cerebral haemorrhage
  1. William B Lo1,
  2. David J Wilcock2,
  3. Martyn Carey3,
  4. Erminia Albanese1
  1. 1Department of Neurosurgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
  2. 2Department of Neuroradiology, University Hospital of North Staffordshire, Stoke-on-Trent, UK
  3. 3Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to Mr W B Lo, Department of Neurosurgery, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent ST4 6QG, UK; williamlo{at}doctors.org.uk

https://doi.org/10.1136/jnnp-2013-305552

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    Case report

    A 46-year-old, previously well, right-handed man presented with a 1 week history of headache, vomiting and confusion. On examination his temperature was 38.3°C, Glasgow Coma Scale score was 14/15 (E4V4M6) and he was severely expressively dysphasic. There was no limb weakness. Initial blood tests, including C reactive protein, were normal. Cranial CT revealed a hypodense area in the left anteromedial temporal lobe (figure 1). Microscopy of CSF from a lumbar puncture showed a pleocytosis (390×106/ml, lymphocytes 95%), with no organism.

    Figure 1

    Axial CT demonstrating an area of hypodensity in the left anteromedial temporal lobe (arrowhead).

    On a working diagnosis of herpes simplex virus (HSV) encephalitis, empirical intravenous aciclovir was commenced. PCR of the CSF later confirmed HSV type 1. Subsequent HIV tests were negative. On day 3, MRI showed a recent small haemorrhage (figure 2). On day 6, the patient developed an acute right-sided hemiplegia. Urgent CT revealed a temporal lobe acute haematoma (figure 3 …

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    Footnotes

    • Contributors Author contributions to the manuscript preparation include the following. Literature review and drafting of the article: WBL. Data interpretation: DJW and MC. Critically revising the article: all authors.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.