title: Intracerebral hematoma complicating herpes simplex encephalitis.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Neurology, Hospital de Galdakao, Galdakao, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Rodríguez-Sainz
authors.forename: Inés
authors.initials: I
authors.lastname: Escalza-Cortina
authors.forename: Laura
authors.initials: L
authors.lastname: Guio-Carrión
authors.forename: Alexandra
authors.initials: A
authors.lastname: Matute-Nieves
authors.forename: Marian
authors.initials: M
authors.lastname: Gómez-Beldarrain
authors.forename: Guillermo
authors.initials: G
authors.lastname: Carbayo-Lozano
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Monco
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000601:surgery; D056424:Decompressive Craniectomy; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000150:complications / Q000601:surgery; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D019635:Neurosurgical Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir
keywords: Brain hematoma; Brain hemorrhage; Encephalitis; Herpes simplex virus; Intracranial bleeding