title: A review of the combined medical and surgical management in patients with herpes simplex encephalitis.
abstract: BACKGROUND
  Herpes simplex encephalitis (HSE) is a devastating and severe viral infection of the human central nervous system. This viral encephalitis is well known to cause severe cerebral edema and hemorrhagic necrosis with resultant increases in intracranial pressure (ICP). While medical management has been standardized in the treatment of this disease, the role of aggressive combined medical and surgical management including decompressive craniectomy and/or temporal lobectomy has not been fully evaluated. In addition, while barbiturate coma has been studied for treatment of status epilepticus associated with infectious encephalitis, its use for treatment of encephalitis associated intractable intracranial hypertension has not been fully reported.
  
  
  METHODS
  We report the case of a 22 year old female with severe herpetic encephalitis requiring aggressive ICP management utilizing all modalities (both medical and surgical) known to control ICP. She continues to have memory deficits but has made a good recovery with a Glasgow Outcome Scale score of 5.
  
  
  CONCLUSIONS
  We provide evidence that aggressive combined medical and surgical therapy is warranted even in cases of severe HSE with transtentorial herniation, as there is evidence for the potential of good recovery. A detailed literature review of the medical and surgical management strategies in this disease is presented.
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, USA.
authors.forename: Mina G
authors.initials: MG
authors.lastname: Safain
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Roguski
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Kryzanski
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, USA. Electronic address: sweller@tuftsmedicalcenter.org.
authors.forename: Simcha J
authors.initials: SJ
authors.lastname: Weller
mesh_terms: D000328:Adult; D020803:Encephalitis, Herpes Simplex / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D055815:Young Adult
keywords: Craniectomy; HSV; Herpes simplex; ICP; Intracranial pressure