Clinical Analysis of Herpes Simplex Virus Encephalitis Misdiagnosed as Brain Contusion and Laceration

LIN Kangyue; LYU Hualiang

doi:10.3969/j.issn.1002-3429.2024.19.003

Abstract：Objective To investigate the clinical features,causes of misdiagnosis and prevention measures of herpes simplex virus encephalitis(HSE)that was initially misdiagnosed as brain contusion and laceration.Methods The clinical data of 2 patients with HSE who were misdiagnosed as brain contusion and lacerations from September 2019 to August 2021 were retrospectively analyzed.Results A young male patient was transferred from another hospital with headache and mental disturbance for 3 d.An elderly woman with a history of hypertension was transferred from another hospital due to being unre-sponsive when called for 2 d and being restless for 1 d.Cerebral imaging of two patients showed multiple brain contusion,which was misdiagnosed as multiple brain contusion,and later confirmed as type 1 HSE by high-throughput genetic detection of pathogenic microorganisms in cerebrospinal fluid.The duration of misdiagnosis was 5 d and 9 d,respectively.Two patients were discharged from hospital after antiviral and immunomodulatory treatment.They were followed up for 6 months with Glas-gow prognostic scale scores of 3 and 5,respectively.Conclusion The clinical manifestations of HSE are not specific,and the imaging and cerebrospinal fluid changes are similar to those of the early brain contusion and lacerations,and the cerebral hemorrhage complicated by HSE is relatively rare.When the medical history is unknown,it is more likely to delay diagnosis and treatment.Understanding the clinical characteristics of the disease,and repeatedly inquiring about the history of such pa-tients,and performing the etiological examination as soon as possible,can improve the diagnosis rate,and reduce or avoid misdiagnosis and treatment.