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J Neurol Surg A Cent Eur Neurosurg 2012; 73(02): 116-122
DOI: 10.1055/s-0032-1309062
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Herpes Simplex Encephalitis after Neurosurgical Operations: Report of 2 Cases and Review of the Literature[*]

D. Kuhnt
1   University Hospital Marburg, Neurosurgery, Marburg, Germany
,
R. Coras
2   University Hospital Erlangen, Neuropathology, Erlangen, Germany
,
I. Y. Eyupoglu
3   University Hospital Erlangen, Neurosurgery, Erlangen, Germany
,
T. Struffert
4   University Hospital Erlangen, Neuroradiology, Erlangen, Germany
,
P. D. Schellinger
5   University Hospital Erlangen, Neurology, Erlangen, Germany
,
M. Buchfelder
3   University Hospital Erlangen, Neurosurgery, Erlangen, Germany
,
C. Nimsky
1   University Hospital Marburg, Neurosurgery, Marburg, Germany
› Author Affiliations
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Publication History

Publication Date:
30 March 2012 (online)

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Herpes Simplex Encephalitis after Neurosurgical Operations: Report of 2 Cases and Review of the LiteratureCent Eur Neurosurg 2011; 72(S 01): e5-e5
DOI: 10.1055/s-0030-1262829

Background and Study Aims

Herpes simplex virus (HSV) is the most common cause of sporadic encephalitis. Although meningitis or other intracranial infections of bacterial origin after craniotomy are well-known complications, herpes simplex encephalitis (HSE) has been reported in only 9 cases so far.

Here we present 2 further cases of HSE after neurosurgical intervention, which occurred within a time period of 3 months. Despite aggressive antiviral therapy with acyclovir, both young and immunocompetent patients died after a relatively short postoperative course. This corresponds well with the other reported cases, in which only 3 out of 9 patients survived.

In case of central nervous system (CNS) infection of unknown origin, HSE should always be considered a possible source. We would like to emphasize the importance of an early diagnosis and antiviral therapy. In both our cases, an initial antibiotic therapy was started. It has to be taken into account that HSE should have been an earlier tentative diagnosis followed by immediate antiviral therapy.

* This article was originally Published online in Central European Neurosurgery on March 28, 2011 (DOI:10.1055/s-0030-1262829)


 

  • References

  • 1 Baringer JR. Herpes simplex encephalitis. Infectious diseases of the nervous system. In: Davis LE, Kennedy PGE, (eds). . Oxford: Butterworth Heinemann; 2000: 139-164
    Google Scholar
  • 2 Berry JD, Girkin CA, Miller NR , et al. Herpes simplex encephalitis and biltateral acute retinal necrosis after craniotomy. Am J Ophthalmol 1998; 126: 456-460
    CrossrefPubMedGoogle Scholar
  • 3 Bourdaries B, Perro G, Cutillas M. Herpes simplex virus infection in burned patients: epidemiology of 11 cases. Burns 1996; 22: 287-290
    CrossrefPubMedGoogle Scholar
  • 4 Bourgeois M, Vinikoff L, Lellouch-Tubiana A , et al. Reactivation of herpes virus after surgery for epilepsy in a pediatric patient with mesial temporal sclerosis: a case report. Neurosurgery 1999; 44: 633-636
    PubMedGoogle Scholar
  • 5 Dennet C, Cleator GM, Klapper PE. HSV-1 and HSV-2 in herpes encephalitis. A study of sixty-four cases in the United Kingdom. J Med Virol 1997; 53: 1-3
    CrossrefPubMedGoogle Scholar
  • 6 Dragoje S, Tolnay M, Dalquen P. Brain irradiation and antioedematous dexamethasone treatment: risk factors for herpes simplex encephalitis?. Schweiz Arch Neurol Psychiatr 1995; 146: 277-280
    PubMedGoogle Scholar
  • 7 Esiri MM, Tomlinson AH. Herpes simplex encephalitis. Immunohistological demonstration of spread of virus via olfactory and trigeminal pathways after infection of facial skin in mice. J Neurol Sci 1984; 64: 213-217
    CrossrefPubMedGoogle Scholar
  • 8 Fearnside MR, Grant JMF. Acute necrotizing encephalitis complicating bifrontal craniotomy and pituitary curretage. J Neurosurg 1972; 36: 499-502
    PubMedGoogle Scholar
  • 9 Kuhn J, Wieland U, Müller W , et al. Herpes simplex type 1 encephalitis. Medizinische Klinik 1990; 99: 441-446
    PubMedGoogle Scholar
  • 10 Lipkin WI. European conciousone viral encephalitis. Lancet 1997; 349: 299-300
    CrossrefPubMedGoogle Scholar
  • 11 Nabors MW, Francis CK, Kobrine AI. Reactivation of herpes virus in neurosurgical patients. Neurosurg 1986; 19: 599-603
    CrossrefPubMedGoogle Scholar
  • 12 Ochsner F. Contamination of a glioma by herpes simplex virus (in French). Schweiz Arch Neurol Neurochir Psychiatr 1981; 129: 19-30
    PubMedGoogle Scholar
  • 13 Ploner M, Turowski B, Wooker H. Herpes encephalitis after meningioma resection. Neurology 2005; 65: 1674
    CrossrefPubMedGoogle Scholar
  • 14 Porteous C, Bradley JA, Hamilton DN. Herpes simplex virus reactivation in surgical patients. Crit Care Med 1984; 12: 626-628
    CrossrefPubMedGoogle Scholar
  • 15 Schmutzhard E. Viral infections of the CNS with special emphasis on herpes simplex infections. J Neurol 2001; 248: 469-477
    CrossrefPubMedGoogle Scholar
  • 16 Schroth G, Gawehn J, Thron A. Early diagnosis of herpes simplex encephalitis by MRI. Neurology 1987; 37: 179-183
    CrossrefPubMedGoogle Scholar
  • 17 Schwab S, Junger E, Spranger L. Craniectomy: an aggressive treatment approach in severe encephalitis. Neurology 1997; 48: 412-417
    CrossrefPubMedGoogle Scholar
  • 18 Sheleg SV, Nedzved MK, Nedzved AM , et al. Contamination of glioblastoma multiforme with type 1 herpes simplex virus. J Neurosurg 2001; 95: 721
    CrossrefPubMedGoogle Scholar
  • 19 Spuler A, Blaszyk H, Parisi JE , et al. Herpes simplex encephalitis after brain surgery: case report and review of the literature. J Neurol Neurosurg Psychiatry 1999; 67: 239-242
    CrossrefPubMedGoogle Scholar
  • 20 Stroop WG, McKendall RR, Battles EJ , et al. Spread of herpes simplex virus type 1 in the central nervous system during experimentally reactivated encephalitis. Microb Pathol 1990; 8: 119-134
    PubMedGoogle Scholar
  • 21 Struffert T, Reith W. Herpes simplex virus encephalitis: neuroradiological diagnosis. Radiologe 2000; 40: 1011-1016
    CrossrefPubMedGoogle Scholar
  • 22 Tyler K. Herpes simpex infections in the central nervous system: encephalitis and meningitis including Mollaret's. Herpes 2004; 11: 57A-64A
    PubMedGoogle Scholar
  • 23 Vital C, Monlun E, Vital A. Concurrent herpes simplex type 1 necrotizing encephalitis, cytomegalievirus ventriculoencephalitis and cerebral lymphoma in an AIDS patient. Acta Neuropathol 1995; 89: 105-108
    CrossrefPubMedGoogle Scholar
  • 24 Whitley RJ. Viral encephalitis. N Engl J Med 1990; 323: 242-250
    CrossrefPubMedGoogle Scholar