| Summary: | Background: Viral encephalitis is a most lethal clinical syndrome associated with severe morbidity and mortality. Viral encephalitis presenting with acute hydrocephalus is a very rare presentation with few cases documented in literature so far. Case: Author reported a case of 23 year male with history of fever, headache and altered sensorium with GCS (11/15). On evaluation with MRI (Magnetic resonance imaging) brain, there was dilated bilateral lateral and third ventricle suggestive features of acute hydrocephalus. Ventriculoperitoneal (VP) shunt was done in view of obstructive hydrocephalus. CSF was sent for routine and PCR (polymerase chain reaction) examination for common viruses. However, patient did not improve clinically and neurologically following VP Shunt and GCS dropped to 7/15 (E2V2M3). Patient was further evaluated with MRI brain, which was suggestive of florid radiological features of viral encephalitis. Meanwhile PCR results too came positive for HSV-1 confirming diagnosis of viral encephalitis. Conclusion: Acute hydrocephalus can be a rare presentation of viral encephalitis in adolescents and should be further evaluated with repeat imaging and CSF for common viral PCR to rule out viral encephalitis as in our case.
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