Cerebral Venous Thrombosis as Rare Presentation of Herpes Simplex Virus Encephalitis.
José LeiteAna RibeiroDiana GonçalvesJoão Sargento-FreitasLuís TrindadeVictor DuquePublished in: Case reports in infectious diseases (2019)
Herpes simplex virus 1 is a prevalent neurotropic pathogen that infects and establishes latency in peripheral sensory neurons. It can migrate into the central nervous system and cause encephalitis. The association between herpes simplex virus encephalitis and cerebral venous thrombosis is rare, with a very limited number of case reports described in the literature, despite the recognized thrombogenic effects of the virus. A 44-year-old man was brought to the emergency department with generalized tonic-clonic seizures requiring sedation and ventilation to control it. Initial brain computed tomography revealed cortical and subcortical edema on the left frontal lobe, and a subsequent contrast-enhanced exam showed absence of venous flow over the anterior half of the superior sagittal sinus. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 1, and the patient was started on acyclovir and anticoagulation, with clinical improvement. Acyclovir administration was maintained for 14 days and oral anticoagulation for one year, with no recurrence of thrombotic events or other complications. A well-timed treatment has a validated prognostic impact on herpes simplex encephalitis, making early recognition of its clinical aspects of main importance.
Keyphrases
- herpes simplex virus
- contrast enhanced
- computed tomography
- emergency department
- cerebrospinal fluid
- magnetic resonance imaging
- case report
- atrial fibrillation
- diffusion weighted
- magnetic resonance
- subarachnoid hemorrhage
- venous thromboembolism
- cerebral ischemia
- positron emission tomography
- systematic review
- functional connectivity
- resting state
- mechanical ventilation
- risk factors
- spinal cord
- diffusion weighted imaging
- dual energy
- brain injury
- candida albicans
- multiple sclerosis
- spinal cord injury
- respiratory failure
- blood brain barrier
- combination therapy
- drug induced