Ictal asystole secondary to suspected herpes simplex encephalitis: a case report

Herpes simplex virus is a leading cause of sporadic encephalitis. While seizures are a common feature of Herpes simplex virus encephalitis, and periods of asystole have been reported in Herpes simplex virus patients, there have been no prior reports of ictal asystole secondary to such an infection.This case report describes a 33 year old, previously healthy, gentleman of Malaysian descent, with new onset seizures resulting in a twenty-one second period of ictal asystole. In hospital the patient developed focal neurological symptoms. A diagnosis of Herpes simplex virus encephalitis was made, although this diagnosis was not confirmed by lumbar puncture, magnetic resonance imaging or biopsy.Literature is reviewed regarding ictal asystole as well as clinical features and cardiac complications of Herpes simplex virus encephalitis. Given the link between ictal asystole and Herpes simplex virus encephalitis, cardiac monitoring would be recommended for Herpes simplex virus encephalitis patients having seizures. The use of anticonvulsants with cardiac side effects should be carefully considered.