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Table 3 Characteristics of patients with hemorrhagic manifestations of HSV CNS infection

From: Cerebrovascular manifestations of herpes simplex virus infection of the central nervous system: a systematic review

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)
  1. *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