Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection.

单纯疱疹病毒 2 (HSV-2) 是一种非常罕见的中枢神经系统 (CNS) 感染原因。我们报告了一例患有左侧大脑中动脉 (MCA) 缺血性中风的年轻女性。患者有 HIV-1 感染史，有一段时间不依从治疗。最初的计算机断层扫描 (CT) 成像研究显示左侧 MCA 的 M1 段狭窄，磁共振成像 (MRI) 证实了 MCA 区域的梗塞。连续经颅多普勒超声显示 MCA 进行性闭塞和左大脑前动脉狭窄。对其他卒中原因的系统调查是正常的。腰椎穿刺显示轻度炎症性脑脊液，通过 PCR 鉴定出 HSV-2 DNA，病毒载量呈阳性，有利于主动复制。没有发现其他病毒或微生物感染。MRI 血管造影证实了累及左颈动脉的血管炎过程，并假设诊断为 HSV-2 血管炎。随着临床特征和影像学异常的改善，患者开始使用阿昔洛韦。在 HIV 感染患者中，中风是导致发病的多因素常见原因。医生应考虑广泛的鉴别诊断，包括罕见原因和常见病因的非典型表现，包括 HSV-1 和 HSV-2 CNS 感染。中风是一种多因素常见的发病原因。医生应考虑广泛的鉴别诊断，包括罕见原因和常见病因的非典型表现，包括 HSV-1 和 HSV-2 CNS 感染。中风是一种多因素常见的发病原因。医生应考虑广泛的鉴别诊断，包括罕见原因和常见病因的非典型表现，包括 HSV-1 和 HSV-2 CNS 感染。