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
|October 2, 2010
Summary
Herpes encephalitis can be fatal, even with early treatment. Prompt decompressive hemicraniectomy in a severe case led to a satisfactory recovery, demonstrating its life-saving potential.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Herpes encephalitis is a severe neurological condition often requiring prompt treatment.
- Despite acyclovir therapy, rapidly progressive cerebral edema can lead to poor outcomes.
- Early intervention is crucial for managing life-threatening complications.
Observation:
- A 66-year-old patient presented with herpes encephalitis and a low Glasgow Coma Score (GCS) of 6.
- The patient exhibited signs of incipient uncus herniation on the third day of illness.
- This indicated severe brain swelling and imminent neurological compromise.
Findings:
- Decompressive hemicraniectomy was performed emergently to alleviate intracranial pressure.
- The surgical intervention successfully managed the cerebral edema.
- The patient experienced a favorable long-term outcome following the procedure.
Implications:
- Decompressive hemicraniectomy is a viable and potentially life-saving treatment for severe herpes encephalitis with cerebral edema and herniation.
- Early surgical intervention can significantly improve neurological outcomes in critical cases.
- This case highlights the importance of aggressive management strategies in herpes encephalitis.
Related Concept Videos
01:26Encephalitis ll: Pathophysiology
Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
01:19Encephalitis l: Introduction
Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
01:26Brain Abscess l: Introduction
A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
01:27Cryptococcal Meningitis
Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...