Intracranial Hemorrhage Complicating Herpes Simplex Encephalitis on Antiviral Therapy: A Case Report and Review of the Literature

Figure 2

(Day 2) ((a) and (b)) noncontrast MRI of the brain: Diffusion Weighted Imaging (DWI) demonstrates increased signal in the right temporal lobe (a) and right insula (b), consistent with cytotoxic edema. Restricted diffusion is less intense as compared to infarction. These imaging findings in combination with clinical scenario are highly suggestive of herpes simplex encephalitis. ((c) and (d)) Noncontrast MRI of the brain: FLAIR sequence demonstrates asymmetrical involvement of the right medial temporal lobe (c) and the insular cortex (d). Unlike in middle cerebral territory infarct, basal ganglia is spared. Arrows in (a) refer to increased signal in right temporal lobe, in (b) increased signal in right insula, in (c) FLAIR sequence demonstrating involvement of right medial temporal lobe, and in (d) FLAIR sequence demonstrating involvement of right insular cortex.

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