Fukushima Yutaka, Tsuchimochi Hirohito, Hashimoto Masanori, Yubi Tomohiro, Nakajima Yutaka, Fukushima Takeo, Inoue Tooru
Department of Neurosurgery, Japanese Red Cross Fukuoka Hospital, Okusu 3-1-1 Minami-ku, Fukuoka 815-0082, Japan.
No Shinkei Geka. 2010 Feb;38(2):171-6.
We report a case of a 35-year-old female with herpetic meningoencephalitis confirmed by polymerase chain reaction and immunohistochemical study for herpes simplex virus-1 accompanied with a massive intracerebral hematoma as a complication. A hematoma localized at the medial temporal lobe and the medial frontal lobe occurred on the 11th day after initiation of acyclovir treatment. She subsequently required emergency surgery for temporal lobectomy, as well as hematoma and external decompression. Intracerebral hematoma with MR imaging showed gyral pattern along the cortex of the medial temporal lobe and the base of the medial frontal lobe. We speculate that the hemorrhage occurred by rupture of small vessels affected by vasculitis in addition to hypertension caused by increased intracranial pressure. We therefore emphasize the risk of intracerebral hemorrhage at an early stage or during acyclovir treatment, especially during one or two weeks after initiation of the treatment, and the necessity of careful observation during these periods.
我们报告一例35岁女性疱疹性脑膜炎病例，经聚合酶链反应及单纯疱疹病毒-1免疫组化研究确诊，并伴有巨大脑内血肿这一并发症。血肿位于颞叶内侧和额叶内侧，在阿昔洛韦治疗开始后第11天出现。她随后需要紧急手术行颞叶切除术以及血肿清除和外减压术。脑内血肿的磁共振成像显示沿颞叶内侧皮质和额叶内侧底部的脑回样形态。我们推测，除了颅内压升高导致的高血压外，出血是由受血管炎影响的小血管破裂所致。因此，我们强调在疾病早期或阿昔洛韦治疗期间，尤其是治疗开始后的一两周内发生脑出血的风险，以及在此期间进行仔细观察的必要性。
