Intracranial Hemorrhage with Hemiparesis as a Complication of Afebrile Herpes Simplex Encephalitis in an Infant
Anjali Gupta, Nikita Tripathi, Atahar Jamal, Tapan SinghAbstract
Background:
Herpes simplex encephalitis (HSE) is the most common cause of sporadic viral encephalitis in children. Atypical presentation with delayed manifestation of intracranial bleed has rarely been reported.
Clinical Description:
A 5-month-old male infant presented with left-sided abnormal movements and weakness for 3 days, without any febrile prodromal symptoms. On examination, the infant was conscious with stable vitals, decreased tone and power in the left upper and lower limbs. Evaluation prior to presentation at our center had revealed a subdural hemorrhage in computed tomography.
Management and Outcome:
Investigations showed a normal hemogram and coagulation profile. Electroencephalography revealed right hemispheric periodic epileptiform discharges with focal slowing over the right frontotemporal region. Contrast-enhanced magnetic resonance imaging of the brain demonstrated T2/FLAIR hyperintense areas involving cortical and subcortical white matter of the right cerebral hemisphere correlating with diffusion restriction, suggestive of encephalitis, with associated subdural hemorrhage. Cerebrospinal fluid analysis showed normal cytology and biochemistry, with positive herpes simplex virus (HSV)-1 polymerase chain reaction (PCR). Intravenous acyclovir was administered for 21 days with antiepileptic therapy and supportive care, resulting in neurological improvement.
Conclusion:
This case highlights a rare case of an afebrile, infantile HSE with isolated intra-cranial hemorrhage, diagnosed after imaging and HSV PCR testing.