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

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.