Early decompressive hemicraniectomy in fulminant herpes simplex encephalitis
N Maraite1, F Mataigne, V Pieri
1Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.
Bulletin De La Societe Des Sciences Medicales Du Grand-Duche De Luxembourg
|January 6, 2010
Summary
Herpes encephalitis can be fatal, but decompressive hemicraniectomy can improve outcomes in severe cases. This procedure helped a patient with brain swelling achieve a satisfactory long-term recovery.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Herpes encephalitis is a severe neurological condition often requiring prompt treatment with acyclovir.
- Rapidly progressive cerebral edema can lead to poor outcomes despite antiviral therapy.
Observation:
- A 66-year-old patient presented with herpes encephalitis, a Glasgow Coma Score (GCS) of 6, and signs of uncal herniation.
- The patient developed incipient uncus herniation of the right temporal lobe on the third day of illness.
Findings:
- Decompressive hemicraniectomy was performed emergently to address the critical brain swelling.
- The patient experienced a satisfactory long-term outcome, regaining unassisted gait and achieving a Barthel Index score of 70 after 9 months.
Implications:
- Decompressive hemicraniectomy is a potentially life-saving intervention for herpes encephalitis with severe cerebral edema and herniation.
- Early surgical intervention can significantly improve neurological function and quality of life in patients with severe herpes encephalitis.
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