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KMID : 0911820180190020081
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Korean Journal of Headache
2018 Volume.19 No. 2 p.81 ~ p.85
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Herpes Simplex Virus Encephalitis Complicated by Cerebral Venous Sinus Thrombosis Presenting with New-onset Headache
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Lee Hee-Jin
Kim Byung-Su
Park Yun-Kyung
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Abstract
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We present a case of cerebral venous thrombosis (CVT) associated with herpes simplex virus (HSV) encephalitis. A patient presented with new-onset seizure preceded by 5 days of a headache with a generalized pressing nature and fever. She was diagnosed with HSV encephalitis and treated with intravenous acyclovir. She showed improvement until a new type of headache occurred. On the twelfth day of treatment, she developed a throbbing headache with localized occiput. Cerebrospinal fluid (CSF) analysis was repeated, but it showed an improvement compared with the initial CSF study. The follow-up brain magnetic resonance imaging (MRI) showed a lack of flow void in the left sigmoid sinus, which was not found in the previous brain MRI. Magnetic resonance venography confirmed the diagnosis of a small amount of CVT. Investigation into other thrombophilic conditions gave negative results. She was clinically stable with only acyclovir and pain control, even without anticoagulation. After two months, follow-up brain MRI showed the disappearance of the thrombus. Our case suggests that CVT should be considered if there is a new-onset headache after appropriate HSV encephalitis treatment.
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KEYWORD
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Herpes simplex encephalitis, Cerebral venous thrombosis, Headache
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