Abstract Details

Title A Novel Case of Herpes Simplex Encephalitis Complicated by Cerebral Venous Thrombosis

Topic Infectious Disease

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-037

Objective We report a novel case of cerebral spinal fluid (CSF) confirmed herpes simplex virus type 1 (HSV-1) encephalitis complicated by subsequent cerebral venous sinus thrombosis (CVST) in a 59 year-old Caucasian woman.

Background HSV-1 is a common and often fatal cause of acute encephalitis. CVST as a complication of laboratory confirmed HSV is rarely reported. There has been one case previously reported in a 23 year-old Sudanese male with suspicion of HSV encephalitis on imaging but not confirmed by spinal fluid testing.

Design/Methods A case study on the general neurology inpatient service at our institution. A review of the English literature was conducted using PubMed.

Results A 59 year-old woman presented with one week of confusion, aphasia, and headache. Spinal fluid was positive for HSV-1. MRI revealed diffusion restriction of the left temporal lobe with no hemorrhagic components. EEG demonstrated lateralized periodic discharges but no electrographic seizure patterns. She was placed on levetiracetam prophylactically and completed twenty-one days of intravenous Acyclovir. She was discharged home with improving cognitive function and resolved headache. She was readmitted five days later with worsening headache and emesis. Intracranial imaging revealed new CVST of the left transverse sinus and superior sagittal sinus without hemorrhage which was not present on prior imaging. Repeat lumbar puncture revealed absence of HSV-1. Hypercoagulable panel was negative and the patient was a non-smoker. The patient received heparin and transitioned to coumadin for six months without complication.

Conclusions

This is the first definite case report of CSF confirmed HSV encephalitis complicated by subsequent CVST following twenty-one days of IV Acyclovir treatment. We propose that the CVST was provoked by the preceding HSV infection; the pathophysiology can be explained by Virchow’s triad: endothelial injury, stasis of blood, and activation of coagulation. Clinicians should have a high suspicion of CVST as a potential sequela to HSV encephalitis.

Authors/Disclosures
Preston J. Eibling, MD (Ohio Health) PRESENTER	No disclosure on file
Jenna A. Brunn, MD (The Oak Clinic)	Dr. Brunn has nothing to disclose.
Mary S. Feldman, DO, FAAN (Dartmouth Hitchcock Medical Center)	Dr. Feldman has nothing to disclose.

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