Case Description:

A 28-year-old postpartum woman presented with severe headache, fever, and decreased level of consciousness. Cerebrospinal fluid PCR detected 185,000 copies of Epstein-Barr virus DNA.

Clinical Findings:

Neuroimaging revealed diffuse cerebral edema consistent with intracranial hypertension in the absence of hemorrhagic lesions, confirming Epstein-Barr virus encephalitis complicated by objectively documented elevated intracranial pressure.

Treatment and Outcomes:

The patient received intravenous acyclovir, phenytoin, and hypertonic saline, achieving complete neurological recovery after 21 days of therapy.

Clinical Relevance:

To our knowledge, this is the first documented case of non-hemorrhagic Epstein-Barr virus encephalitis with objectively confirmed intracranial hypertension in the postpartum period. The most plausible mechanism is inflammation-induced diffuse cerebral edema leading to impaired cerebrovascular autoregulation and subsequent intracranial pressure elevation. Clinicians should include Epstein-Barr virus infection in the differential diagnosis of postpartum patients presenting with encephalitis and signs of increased intracranial pressure, even when neuroimaging does not reveal hemorrhagic findings.

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