Abstract：
UNASSIGNED: Herpes simplex virus encephalitis (HSVE) is associated with significant morbidity and mortality. Here, we present the occurrence of HSVE in a 36-year-old immunocompetent patient following craniotomy for a traumatic acute subdural hematoma (ASDH).
UNASSIGNED: Imaging after four days of progressive headache following a fall with head-strike demonstrated a 1 cm thick left holohemispheric ASDH with significant cerebral compression, edema, and 8 mm of left-to-right midline shift, and an emergent craniotomy and ASDH evacuation were performed, with additional treatment needed for reaccumulation. Postoperatively, the patient developed a worsening leukocytosis, became febrile, and was hypotensive requiring vasopressor support.
UNASSIGNED: Despite empiric antibiotics, the patient remained persistently febrile with significant leukocytosis. Repeat head CT showed a new left insular hypodensity and a subsequent viral encephalitis panel was positive for HSV-1. The patient was then started on intravenous acyclovir, with progressive neurological exam improvement. Of note, the patient was noted to have a positive serum HSV-1 IgG antibody titer, indicative of prior infection.
UNASSIGNED: Given the known systemic immunosuppression in brain injury and the high prevalence of HSV seropositivity, clinicians should consider the possibility of HSVE from HSV reactivation in TBI patients with persistent fever, leukocytosis, and/or neurological deficits without an obvious etiology.
UNASSIGNED: Imaging after four days of progressive headache following a fall with head-strike demonstrated a 1 cm thick left holohemispheric ASDH with significant cerebral compression, edema, and 8 mm of left-to-right midline shift, and an emergent craniotomy and ASDH evacuation were performed, with additional treatment needed for reaccumulation. Postoperatively, the patient developed a worsening leukocytosis, became febrile, and was hypotensive requiring vasopressor support.
UNASSIGNED: Despite empiric antibiotics, the patient remained persistently febrile with significant leukocytosis. Repeat head CT showed a new left insular hypodensity and a subsequent viral encephalitis panel was positive for HSV-1. The patient was then started on intravenous acyclovir, with progressive neurological exam improvement. Of note, the patient was noted to have a positive serum HSV-1 IgG antibody titer, indicative of prior infection.
UNASSIGNED: Given the known systemic immunosuppression in brain injury and the high prevalence of HSV seropositivity, clinicians should consider the possibility of HSVE from HSV reactivation in TBI patients with persistent fever, leukocytosis, and/or neurological deficits without an obvious etiology.
摘要：
■单纯疱疹病毒性脑炎(HSVE)与显著的发病率和死亡率相关。这里,我们介绍了一名36岁的免疫功能正常的患者在开颅手术治疗外伤性急性硬膜下血肿（ASDH）后发生HSVE的情况。
■在头部撞击后跌倒后的进行性头痛四天后的成像显示出1厘米厚的左全半球ASDH，并伴有明显的脑压迫，水肿,和8毫米左右的中线偏移，进行了紧急开颅手术和ASDH疏散，再积累需要额外的治疗。术后,患者出现白细胞增多恶化,变得发热，低血压需要血管加压药支持.
■尽管经验性抗生素，患者持续发热并伴有显著的白细胞增多。重复头部CT显示新的左岛低密度，随后的病毒性脑炎面板对HSV-1呈阳性。然后病人开始静脉注射阿昔洛韦，随着神经系统检查的进步。值得注意的是，患者血清HSV-1IgG抗体滴度呈阳性,指示先前的感染。
■鉴于已知的脑损伤中的全身性免疫抑制和HSV血清阳性的高患病率，临床医生应考虑持续发热的TBI患者因HSV再激活引起HSVE的可能性,白细胞增多,和/或没有明显病因的神经功能缺损。
■在头部撞击后跌倒后的进行性头痛四天后的成像显示出1厘米厚的左全半球ASDH，并伴有明显的脑压迫，水肿,和8毫米左右的中线偏移，进行了紧急开颅手术和ASDH疏散，再积累需要额外的治疗。术后,患者出现白细胞增多恶化,变得发热，低血压需要血管加压药支持.
■尽管经验性抗生素，患者持续发热并伴有显著的白细胞增多。重复头部CT显示新的左岛低密度，随后的病毒性脑炎面板对HSV-1呈阳性。然后病人开始静脉注射阿昔洛韦，随着神经系统检查的进步。值得注意的是，患者血清HSV-1IgG抗体滴度呈阳性,指示先前的感染。
■鉴于已知的脑损伤中的全身性免疫抑制和HSV血清阳性的高患病率，临床医生应考虑持续发热的TBI患者因HSV再激活引起HSVE的可能性,白细胞增多,和/或没有明显病因的神经功能缺损。
