Herpes Simplex Meningitis After Removal of a Vestibular Schwannoma

Abstract

The diagnosis of herpes simplex viral meningitis should be suspected in clinical cases of postsurgical meningitis with a lymphocyte predominant pleocytosis and negative bacterial cultures. Antiviral therapy should be initiated immediately after confirmatory polymerase chain reaction testing to avoid potential long-term sequelae of a herpes simplex infection of the central nervous system.

Herpes simplex meningitis after vestibular schwannoma surgery: illustrative case

“…Few cases are reported in the literature; 1 , 3 , 5–11 5 of them concerned patients with vestibular schwannomas. 6 , 12–15 Only one case of herpes meningitis without encephalitis 12 has been reported so far. If not immediately treated, herpes meningitis is usually lethal.…”

Herpes simplex reactivation following neurosurgery: case report and review of the literature

“…In our review of 40 cases of postoperative neurosurgical patients with HSV diagnosis following craniotomy, 12 (30%) patients died and 1 had unreported outcome due to hospital transfer. [1][2][3][4][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]26,[30][31][32][33][34][35][36] Fever, headache, and altered mental status were common presenting symptoms and started anywhere from POD 1 to POD 90, with a majority occurring in a delayed fashion between PODs 7 and 12. 1-4, 6-24, 26, 30-36 Surgical site varied and does not alone explain potential reactivation of HSV, although it is unknown how many of these patients received perioperative steroids.…”