Abstract

Objective

Herpes simplex virus encephalitis (HSVE) represents the most common cause of sporadic encephalitis in humans. The development of intracerebral hematomas is rare and late during the course of HSVE. To report a case of a patient with HSVE who initially presented a diffuse intracranial hemorrhage with predominant intraventricular bleeding.

Case report

A 66-year-old man was admitted to the Emergency Department with acute headache. Antecedents: alcohol consumption and ethylic hepatopathy. The brain computed tomography showed acute tetraventricular hemorrhage and hydrocephalus. The blood analysis showed pancytopenia and alteration of all hepatic parameters. After external drainage of cerebrospinal fluid the patient presented a worsening of headache, disorientation, mild left hemiparesis, neck stiffness and temperature of 37.6 °C. The cerebrospinal fluid was hemorrhagic, with 3 lymphocytes/mm3, 60 mg/dL of proteins and PCR positive for Herpes simplex virus type 1. The patient improved with intravenous acyclovir, however he experienced several medical complications which caused his dead.

Discussion

The patient presented an atypical cerebral bleeding related to HSVE because the development of hematoma was early and the topography of hemorrhage was basically intraventricular. Probably, both atypical characteristics were related to thrombocytopenia and severe coagulation disorder. This case expands the spectrum of cerebrovascular disorders associated with HSVE.

中文翻译：

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脑室内出血作为单纯疱疹病毒性脑炎的临床表现。病例报告及文献复习

摘要

客观的

单纯疱疹病毒性脑炎 (HSVE) 是人类散发性脑炎的最常见原因。在 HSVE 过程中，脑内血肿的发展是罕见的和晚期的。报告一例最初表现为弥漫性颅内出血伴脑室内出血为主的 HSVE 患者的病例。

案例报告

一名 66 岁男子因急性头痛被送入急诊科。前因：饮酒和乙肝。脑计算机断层扫描显示急性四脑室出血和脑积水。血液分析显示全血细胞减少和所有肝脏参数的改变。脑脊液外引流后，患者出现头痛恶化、定向障碍、轻度左侧偏瘫、颈部僵硬和体温 37.6 °C。脑脊液为出血性，3 个淋巴细胞/mm3，60 mg/dL 的蛋白质和 1 型单纯疱疹病毒 PCR 阳性。患者静脉注射阿昔洛韦后病情好转，但他经历了数次导致死亡的医疗并发症。

讨论

患者出现与HSVE相关的非典型脑出血，因为血肿发展较早，出血形态基本在脑室内。可能，这两种非典型特征都与血小板减少症和严重的凝血障碍有关。该病例扩大了与 HSVE 相关的脑血管疾病的范围。