Herpes simplex viral encephalitis complicated with bilateral temporal lobe hemorrhage underwent hematoma evacuation：a case report

Background Herpes simplex encephalitis is a potentially fatal disease. Cases of herpes simplex encephalitis complicated by bilateral temporal lobe hemorrhage are uncommon, and those requiring surgical decompression are even rarer. We therefore report a male patient who underwent neurosurgical intervention for herpes simplex virus encephalitis complicated by bilateral temporal lobe hemorrhage. Case Presentation: A previously healthy male patient was admitted with chief complaints of “fever, seizures, and impaired consciousness.” Initial brain CT and CTP scans showed no abnormalities. Cerebrospinal fluid(CSF) metagenomic next-generation sequencing (mNGS) testing indicated Herpes Simplex Virus-1 (HSV-1), The patient received intravenous acyclovir therapy upon admission. On the 12th hospital day, the patient's coma deepened. Brain CT revealed bilateral temporal lobe hemorrhages with left midline shift. Emergency intracerebral hematoma evacuation (right side) and intracranial decompression (right side) were performed. Two weeks post-admission, repeat CSF mNGS showed improvement compared to baseline. Acyclovir injections were discontinued on the 23rd day. One month post-discharge telephone follow-up confirmed good neurological recovery. Conclusion CSF mNGS aids in early pathogen identification and guides targeted therapy. HSE complicated by intracerebral hemorrhage is prone to misdiagnosis; clinical deterioration warrants prompt neuroimaging evaluation. Surgical decompression should be actively considered for HSE patients with severe hemorrhage.