ヘルペス脳炎治療中に脳出血を合併した1例

A Case of Herpetic Meningoencephalitis Associated with Massive Intracerebral Hemorrhage During Acyclovir Treatment: A Rare Complication

Ⅰ．はじめに

　ヘルペス脳炎は本邦で最も頻度の高い散発性ウイルス脳炎である．今回われわれはヘルペス脳炎治療中にmassiveな脳出血を来し緊急手術となった症例を経験した．ヘルペス脳炎では少量の出血がみられることはあるがmassiveな出血を合併することは稀で，われわれが渉猟し得た範囲では今日までに9例の報告しかなかった^{1,3,6-8,11,13-15)}．症例を提示し，臨床的特徴，特に画像上の特徴と出血の機序につき文献的考察を加え報告する．

　We report a case of a 35-year-old female with herpetic meningoencephalitis confirmed by polymerase chain reaction and immunohistochemical study for herpes simplex virus-1 accompanied with a massive intracerebral hematoma as a complication. A hematoma localized at the medial temporal lobe and the medial frontal lobe occurred on the 11th day after initiation of acyclovir treatment. She subsequently required emergency surgery for temporal lobectomy, as well as hematoma and external decompression. Intracerebral hematoma with MR imaging showed gyral pattern along the cortex of the medial temporal lobe and the base of the medial frontal lobe. We speculate that the hemorrhage occurred by rupture of small vessels affected by vasculitis in addition to hypertension caused by increased intracranial pressure. We therefore emphasize the risk of intracerebral hemorrhage at an early stage or during acyclovir treatment, especially during one or two weeks after initiation of the treatment, and the necessity of careful observation during these periods.