Table 3.
Characteristics of patients with hemorrhagic manifestations of HSV CNS infection
| No. (year), reference | Age, sex | HSV type, diagnostic test, CSF cells count | Initial clinical presentation, other findings | Localization of encephalitis | Localization of bleeding, other characteristics | Time from symptom onset to admission, time from admission to detection of hemorrhage | Presence of vasculitis (affected vessel), treatment | Outcome (mRS) |
|---|---|---|---|---|---|---|---|---|
| 1 (2001), Plantinga E [18] | 36, m | HSV-1, PCR, 33 cells/μl | Encephalitis (fever, consciousness, disorientation) | Left temporal, frontal, and insular areas | Left temporoparietal, hematoma, edema, midline shift | Day 6, day 10 | n.e., dexamethasone | Mild aphasia and short-term memory disturbances (3) |
| 2 (2001), Lee JW [19] | 15, m | HSV*, PCR, 15 cells/μl | Encephalitis (fever, aphasia, confusion) | Both temporal and frontal lobes | Left temporal and frontal lobe, petechial hemorrhage | Day 4, on first imaging | n.e. | Weakness upper extremity (2) |
| 3 (2001), Lee JW [19] | 6, m | HSV*, PCR, 5 cells/μl | Encephalitis (fever, vomiting, altered consciousness) |
Left medial temporal lobe | Left temporal and frontal lobe, hematoma | Day 17, on first imaging | n.e. | Severe bulbar dysfunction (4–5) |
| 4 (2002), Erdem G [20] | 1, f | HSV*, PCR, 33 cells/μl | Encephalitis (seizures, lethargy, fever) | Both temporal, frontal, and parietal lobes | Right temporal lobe, hematoma, edema | Day 6, on first imaging | No | Quadriparesis (4–5) |
| 5 (2004), Biswas A [21] | 38, m | HSV-1, PCR, 0 cells/μl | Encephalitis (headache, disturbed sleep) | Right inferior frontal and medial temporal region | Right frontal and temporal lobe, hematoma, edema | Not specified, not specified | No | Complete recovery (0) |
| 6 (2005), Kabakus N [22] | 3, m | HSV*, antibody, 450 cells/μl | Encephalitis (fever, headache hemiparesis) | Right temporal lobe | Left parietal lobe, hematoma, edema | Day 10, on first imaging | n.e. | Hemiparesis (3) |
| 7 (2005), Jabbour PM [23] | 27, m | HSV-1, PCR, 189 cells/μl | Encephalitis (fever, seizure) | Right mesial temporal lobe | Right temporal lobe, hematoma, uncal herniation, and ventricular blood | Day 2, day 9 | n.e., craniotomy and evacuation of hematoma | No focal neurological signs (0) |
| 8 (2006), Argyriou AA [24] | 22, m | HSV-1, PCR, 425 cells/μl | Encephalitis (seizure, fever, altered consciousness) | Left termporal lobe | Left parietal lobe, hematoma | Day 3, day 11 | n.e. | Complete recovery (0) |
| 9 (2007), Shelley BP [25] | 26, m | HSV*, PCR, 130 cells/μl | Encephalitis (fever, confusion, seizure) | Bilateral medial temporal lobe (left > right) | Left temporal lobe, hematoma | Day 1, day 18 | no | Complete recovery (0) |
| 10 (2008), Gkrania-Klotsas E [26] | 46, m | HSV-1, PCR, 0 cells/μl | Encephalitis (headache, fever, depersonalization) | No lesion | Left parietal lobe, hematoma | Day 7, on first imaging | n.e. | Returned to premorbid mental condition (0–1) |
| 11 (2009), Li JZ [27] | 56, m | HSV-1, PCR, 30 cells/μl | encephalitis (fever, seizure), HIV positive | Left medial temporal lobe | Left temporal lobe and basal ganglia, hematoma, edema, herniation | Day 1, day 6 (no hemorrhage on CT on day 1) | n.e., craniotomy and evacuation of hematoma | Mild neuropsychological deficits (2) |
| 12 (2010), Tonomura Y [28] | 30, f | HSV-1, PCR, 321 cells/μl | Encephalitis (headache, fever, neuropsychological deficits, altered mental state) | Bilateral (left > right) medial temporal and frontal lobes | Left amygdaloid body, hematoma, subarachnoid, and ventricular blood | Day 2, day 5 | n.e. | GCS 14, responds to simple orders (5) |
| 13 (2011), Takeuchi S [29] | 54, m | HSV-1, PCR, 86 cells/μl | Encephalitis (fever, walking difficulty, confusion, seizure) | Right temporal lobe | Temporal lobe, hematoma | Day 2, day 10 | n.e. | Hemiparesis, memory disturbances (3) |
| 14 (2013), Battaglia F [30] | 38, f | HSV-1, PCR, pleocytosis | Encephalitis (headache, fever, hallucinations, speech disturbances) | Diffuse cerebral edema on CT | Left temporal lobe, hematoma, edema with brainstem compression | Day 3, day 9 | n.e., craniotomy and evacuation of hematoma | Died 20 days from symptom onset (6) |
| 15 (2013), Rodriguez-Sainz A [31] | 45, f | HSV-1, PCR, 383 cells/μl | Encephalitis (headache, fever, incoherent speech), hepatitis C infection | Left medial temporal lobe | Left temporal lobe, hematoma, edema, brainstem compression | Day 2, day 9 (no lesion and no hemorrhage on CT on day 1) | n.e., craniotomy and evacuation of hematoma | Residual aphasia and right-sided hemiparesis (3–4) |
| 16 (2013), Rodriguez-Sainz A [31] | 53, f | HSV-1, PCR, 516 cells/μl | Encephalitis (fever, memory problems, headache) | Bilateral temporal lobes and insula | Left temporal lobe, hematoma, blood in subarachnoid space and midline shift | Day 6, day 8 | n.e. | Mild neuropsychological deficits (3) |
| 17 (2014), Yu W [32] | 64, f | HSV*, PCR and brain biopsy, not reported | Encephalitis (headache, leg pain, seizure 5 days later) | Bilateral temporal and frontal lobe | Right temporal lobe, hematoma, raised intracranial pressure | No details, on first imaging | No, craniotomy and evacuation of hematoma | Died on hospital day 25 (6) |
| 18 (2015), Zabroug S [33] | 28, f | HSV-1, PCR, 2/μl | Encephalitis (anterograde amnesia, insomnia), 4 month postpartum | Right temporal lobe | Supra-tentorial blood | No details, no details | No | Not reported |
| 19 (2015), Bhagchandania D [34] | 23, m | HSV*, PCR, 20/μl | Encephalitis (fever, seizures, altered sensorium) | Bilateral temporal and parietal lobe | Left temporal lobe, hematoma | Day 4, day 15 | n.e. | Behavioral abnormality (3–4) |
| 20 (2016), Gaye NM [35] | 53, f | HSV-2, PCR, 88 cells/μl | Encephalitis (recurrent seizures, fever on day 1) | Left mesial temporal lobe | Left temporal lobe, hematoma, ventricular blood | Day 2, day 18 | n.e. | Persistent severe neuropsychological deficits (5) |
| 21 (2017), Harada Y [36] | 71, f | HSV-1, PCR, 170 cells/μl | Encephalitis (fever, headache, altered mental status) | Right anterior medial temporal lobe and insular cortex | Right temporal lobe and right basal frontal lobe, hematoma, intraventricular blood | Day 8, day 14 | No | Near complete recovery (1) |
| 22 (2016), Mahale RR [37] | 71, m | HSV*, PCR, 5 cells/μl |
Encephalitis (fever, headache, altered mental status) | No loco-typico lesions | Left parieto-occipital and right occipital region, hematoma | Day 5, on first imaging | n.e. | Mild improvement of cortical blindness (4) |
| 23 (2016), Fisahn C [38] | 69, f | HSV*, brain biopsy, not reported | Stroke-like (acute onset of headache and right hemiparesis) | No loco-typico lesions | Left parietal lobe, hematoma, subarachnoid hemorrhage | Day 1, on first imaging | n.e. | Died (6) |
| 24 (2017), Mueller K [39] | 40, f | HSV-2, PCR, 558 cells/μl | Unspecific (headache, fever, nausea, vomiting) | CT on first day normal | Right temporal lobe, hemorrhage, midline shift | Day 7, day 14 | No, hemicraniectomy and temporal lobectomy | Survived, no further details reported |
| 25 (2017), El Shimy G [40] | 49, m | PCR negative, 45 cells/μl | Encephalitis (fever, headache, altered mental status) | Right temporal lobe and insula | Right medial temporal lobe, hematoma | Day 2, day 14 | No | Returned to baseline neurological status (0) |
| 26 (2013), Lo WB [41] | 46, m | HSV-1, PCR, 390 cells/μl | Encephalitis (fever, headache, confusion) | Left temporal lobe | Left temporal lobe, hematoma, edema, uncal herniation | Day 7, day 10 | Craniotomy on day 6, removal of anterior temporal lobe and evacuation of hematoma | Gradual improvement, no further details reported |
| 27 (2018), Sivasankar C [42] | 71, f | HSV-1, IHC, n.e. | Encephalitis (decreased responsiveness, hemiparesis, seizure) | Both temporal and parietal lobes | Right temporal lobe, hematoma, edema, uncal herniation | Day 1, day 8 (postoperative) | No, craniotomy for evacuation of hematoma on day 8 | Died on day 17 after hospital admission (6) |
*PCR methodology did not distinguish between HSV-1 and HSV-2. m male, f female, + yes, − no, n.a. not available, CSF cerebrospinal fluid, MCA middle cerebral artery, MP methylprednisone, n.e. not evaluated, MRI magnetic resonance imaging, CT computed tomography, HIV human immunodeficiency virus, IHC immunohistochemistry