title: Hemorrhagic and ischemic stroke secondary to herpes simplex virus type 2 meningitis and vasculopathy.
abstract: Herpes simplex virus type 2 (HSV-2) meningitis dogmatically is benign and self-limited in the immune competent patient. However, we describe how left untreated HSV-2 meningitis can be complicated by vasculitis and both ischemic and hemorrhagic stroke. We report a 57-year-old woman with lymphocytic meningitis complicated by ischemic stroke and intracerebral hemorrhage in the setting of vasculopathy and HSV-2 DNA detected in CSF successfully treated with acyclovir and corticosteroids. Subsequent angiographic magnetic resonance imaging revealed improvement in the vasculopathy after treatment. This case demonstrates that HSV-2 meningitis may take a less benign course and further provides the first evidence of angiographic improvement in addition to clinical improvement after definitive treatment.
authors.affiliation: Departments of Neurology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Snider
authors.forename: Claire S
authors.initials: CS
authors.lastname: Jacobs
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Scripko
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Klein
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Lyons
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy; D018258:Herpesvirus 2, Human; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008587:Meningitis, Viral / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy / Q000821:virology*; D014657:Vasculitis / Q000188:drug therapy / Q000821:virology*
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D000212:Acyclovir