Intracranial hemorrhage and cerebral infarction as clinical presentation of herpes simplex virus encephalitis. A case report

Abstract Background: Herpes simplex virus encephalitis (HSVE) is one of the most common causes of sporadic encephalitis in humans. However, intracranial hemorrhage and cerebral infarction are very rare during the course of HSVE, making timely clinical identification challenging. Case description: A 71-year-old Chinese male was admitted due to “dizziness for three days.” Neurological examination revealed no significant positive signs. Initial cranial CT imaging suggested “possible periventricular hemorrhage with intraventricular extension, potentially related to herpes simplex virus encephalitis.” The initial diagnosis was cerebral hemorrhage. During hospitalization, the patient’s condition progressed with fever, delayed response, delirium, and cranial MRI indicating cerebral infarction and hemorrhage. Cerebrospinal fluid analysis showed elevated white blood cell count and protein levels, decreased glucose, and metagenomic sequencing identified human α-herpesvirus type 1 (HSV-1). The patient’s condition improved following treatment with acyclovir and glucocorticoids. Conclusion: High-throughput genetic pathogen detection plays a crucial role in diagnosing central nervous system infections. Timely recognition of cerebrovascular manifestations in CNS infections and targeted antimicrobial therapy are key to achieving a favorable prognosis.