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

Abstract

<jats:p>Herpes simplex encephalitis is a common viral encephalitis associated with significant morbidity and mortality if not diagnosed and treated early. Neurosurgery may be an impetus for viral reactivation, either from direct nerve manipulation or high-dose steroids often administered during cases. The authors present the 40th known case of herpes simplex virus (HSV) encephalitis following neurosurgical intervention and review the previously reported cases. In their review, the authors observed positive HSV polymerase chain reaction (PCR), which had initially been negative in several cases. In cases in which there is high suspicion of HSV, it may be prudent to continue antiviral therapy and retest CSF for HSV PCR. Antiviral therapy significantly reduces mortality associated with HSV encephalitis.</jats:p>

Herpes simplex virus encephalitis after temporal lobe resection: an infrequent but treatable complication of epilepsy surgery

“…In this context, CSF analysis could be non‐contributory due to the alteration of the normal parameters typically found after surgery. Regarding this, hypoglycorrhachia, as found in our case, may be present in 29% of HSV encephalitis [5] and also can be found in HSV reactivation after neurosurgery [3]. Additionally, MRI findings (T2/FLAIR hyperintensities with ASL hyperperfusion and DWI restriction) may mimic other conditions such as status epilepticus [6].…”

“…Furthermore, recent studies have shown that HSV encephalitis and neurosurgery itself may trigger anti‐NMDA receptor encephalitis [8], and consequently it might also be advisable to rule out the coexistence of this type of autoimmune encephalitis. In the light of this case and other reports [3], preventive treatment with acyclovir in neurosurgical patients with previous history of HSV encephalitis might be considered.…”

“…Additionally, MRI findings (T2/FLAIR hyperintensities with ASL hyperperfusion and DWI restriction) may mimic other conditions such as status epilepticus [6]. Since HSV encephalitis is associated with high rates of mortality and neurological sequelae (30% and 35% respectively) [3,4,7], a high level of suspicion is decisive for a rapid diagnosis, and therefore early empirical treatment with acyclovir might be justified awaiting confirmation by PCR. Furthermore, recent studies have shown that HSV encephalitis and neurosurgery itself may trigger anti-NMDA receptor encephalitis [8], and consequently it might also be advisable to rule out the coexistence of this type of autoimmune encephalitis.…”

“…Thus, it is speculated that surgery around this abnormal brain region could have triggered the reactivation of HSV‐1 that was confined within the temporal lobe. However, reactivation of the HSV within the trigeminal nerve ganglia, in close proximity with the medial temporal region, cannot be ruled out based on our findings [3]. Additionally, treatment with corticosteroids during the first 48 h after surgery could also have been a contributory factor.…”

Morphological and ultrastructural changes in Herpes simplex encephalomyelitis: an attempt to determinate the etiological factor

“…Exclusion of the tumour in the neuropathological examination In the other case with subacute clinical course, extraventricular drainage was implemented to decrease intracranial pressure. According to the literature, decompressive craniectomy or external ventricular drainage seems to be the effective treatment for cerebral oedema or increased intracranial pressure due to infectious encephalitis [1,3,17,20]. Correct diagnosis of HSE still remains challenging, which in relation to frequent rapid course results in consistently high mortality.…”