Decompressive craniectomy as a rescue treatment in Herpes simplex encephalitis-related cerebral edema: a case report and literature review

Authors

  • Rémi Malhomme Intensive Care Unit, University Hospital, Guadeloupe, French West Indies - France https://orcid.org/0000-0002-9707-393X
  • Jean-David Pommier 1. Intensive Care Unit, University Hospital, Guadeloupe, French West Indies - France. 2. Institut Pasteur de la Guadeloupe, Pointe-à-Pitre, France.
  • Laure Flurin Intensive Care Unit, University Hospital, Guadeloupe, French West Indies - France https://orcid.org/0000-0001-5687-1081
  • Michel Carles Intensive Care Unit, University Hospital, Guadeloupe, French West Indies - France https://orcid.org/0000-0001-5485-1511
  • Laurent Do Neurosurgery, University Hospital, Guadeloupe, French West Indies - France

DOI:

https://doi.org/10.37051/mir-00067

Keywords:

craniectomy, encephalitis, decompression, herpes simplex virus, intracranial pressure

Abstract

We present a case of herpes simplex encephalitis requiring decompressive craniectomy for high intracranial pressure, and a review of decompressive craniectomy in herpes simplex encephalitis. 

Case description and review: a 32-year-old man was brought to emergency department for headache and fever. The cerebral spinal fluid examination found lymphocytic meningitis; treatment by acyclovir was initiated 4 days after admission. At day 5, patient developed clinical signs of high intracranial pressure and CT-scan showed cerebral herniation. After medical management fail, a decompressive craniectomy was performed on the same day. The procedure resulted in a good clinical recovery with minor neurological sequelae. A literature review, presented here, found few cases of decompressive craniectomy in herpes simplex encephalitis. Due to a lack of robust clinical data, no guideline are yet available.

In summary, a surgical approach, such as a decompressive craniectomy, in herpes simplex encephalitis with high intracranial pressure should be discussed early, in association with the medical treatment. Prospective data are needed to better define timing of surgery and decision-making criteria.

Published

2021-03-18

How to Cite

Malhomme, R., Pommier, J.-D., Flurin, L., Carles, M., & Do, L. (2021). Decompressive craniectomy as a rescue treatment in Herpes simplex encephalitis-related cerebral edema: a case report and literature review. Médecine Intensive Réanimation. https://doi.org/10.37051/mir-00067

Issue

Section

Commented case report