Herpes Simplex Type 2 Encephalitis After Craniotomy: Case Report and Literature Review.

Abstract:

BACKGROUND:Herpes simplex encephalitis (HSE) after neurosurgical procedures is extremely uncommon, and the few published case reports mainly described herpes simplex virus type 1 (HSV-1) as being culpable. We present a rare case of HSV-2 encephalitis after craniotomy and describe its pathophysiology and optimal management. CASE DESCRIPTION:A 70-year-old woman underwent an elective resection of a recurrent left sphenoid wing meningioma and clipping of a left middle cerebral artery aneurysm, the latter having been found incidentally. She returned to our department with clinical findings suggestive of meningitis 12 days after the operation. Her lack of response to empiric antibiotic treatment, taken together with the lymphocyte-predominant initial cerebrospinal fluid obtained by lumbar puncture and the electroencephalographic indications of encephalopathy, led to the suspicion of a diagnosis of HSE, which was later confirmed by a polymerase chain reaction test positive for HSV-2. The patient was then successfully treated with intravenous acyclovir for 2 weeks followed by another week of oral acyclovir treatment before being discharged. CONCLUSIONS:The present case stresses the importance of recognizing the relatively rare entity of HSE after craniotomy. Timely correct diagnosis will expedite the initiation of appropriate treatment.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Berger A,Shahar T,Margalit N

doi

10.1016/j.wneu.2015.11.101

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

691.e9-691.e12

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(15)01724-6

journal_volume

88

pub_type

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