Intracerebral hematoma complicating herpes simplex encephalitis

Clin Neurol Neurosurg. 2013 Oct;115(10):2041-5. doi: 10.1016/j.clineuro.2013.06.016. Epub 2013 Jul 23.


Objectives: To describe two patients who developed an intracranial hematoma as a complication of temporal lobe encephalitis due to herpes simplex type 1 virus, and to review the literature.

Patients and methods: The first patient, a 45-year-old woman developed a brain hematoma in the location of the encephalitic lesion on day 9 after the onset of herpes simplex encephalitis (HSE) that required surgical evacuation. The second patient, a 53-year-old woman was being treated for HSE; on day 8 after admission a temporal lobe hematoma with midline shift was disclosed due to persistent headache. Both patients survived but were left with sequelae. We conducted a PubMed/MEDLINE search from 1986 to April 2013 on this topic.

Results: We have found 20 additional cases reported in the literature and review their characteristics. Hemorrhage was present on admission in 35% of pooled patients, and consistently involved the area of encephalitis. Clinical presentation of intracranial hemorrhage overlapped the encephalitic symptoms in two-thirds of the patients. Half of patients underwent surgery. Overall, mortality rate was low (5.2%), and half of patients fully recovered.

Conclusions: Intracranial bleeding, although infrequent, can complicate the evolution of herpes simplex encephalitis and should be borne in mind since its presence may require neurosurgery. Although its presentation may overlap the encephalitic features, the lack of improvement or the worsening of initial symptoms, particularly during the second week of admission, should lead to this suspicion and to perform a neuroimaging study.

Keywords: Brain hematoma; Brain hemorrhage; Encephalitis; Herpes simplex virus; Intracranial bleeding.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use
  • Antiviral Agents / therapeutic use
  • Brain / pathology
  • Cerebral Hemorrhage / complications*
  • Cerebral Hemorrhage / surgery
  • Decompressive Craniectomy
  • Encephalitis, Herpes Simplex / complications*
  • Encephalitis, Herpes Simplex / drug therapy
  • Female
  • Glasgow Coma Scale
  • Hematoma / complications
  • Hematoma / surgery
  • Hepatitis C / complications
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Nervous System Diseases / epidemiology
  • Nervous System Diseases / etiology
  • Nervous System Diseases / physiopathology
  • Neurosurgical Procedures
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Antiviral Agents
  • Acyclovir