Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature

• Published in: Virology journal Vol. 13; no. 1; p. 83
• Main Authors: Jaques, David A., Bagetakou, Spyridoula, L’Huillier, Arnaud G., Bartoli, Andrea, Vargas, Maria-Isabel, Fluss, Joel, Kaiser, Laurent
• Format: Journal Article
• Language: English
• Published: London BioMed Central 23.05.2016; BioMed Central Ltd
• Subjects: Antiviral agents; Biomedical and Life Sciences; Biomedicine; Care and treatment; Case Report; cerebrospinal fluid; Cerebrospinal Fluid - virology; Child; Complications and side effects; Encephalitis; Encephalitis, Herpes Simplex - diagnosis; Encephalitis, Herpes Simplex - pathology; Female; Health aspects; herpes simplex; Herpes simplex encephalitis; Herpes viruses; Humans; Infant; magnetic resonance imaging; Male; Middle Aged; Neurosurgical Procedures - adverse effects; pathophysiology; patients; Polymerase Chain Reaction; Postoperative Complications - diagnosis; Postoperative Complications - pathology; Prognosis; Risk factors; Treatment Outcome; Virology; viruses; Young Adult; Postoperative; Encephalitis; Meningitis; Complication; Neurosurgery; Herpes simplex virus
• ISSN: 1743-422X; 1743-422X
• DOI: 10.1186/s12985-016-0540-4

Background Herpes simplex virus (HSV) is the most common identified cause of focal encephalitis worldwide. However, postoperative HSV encephalitis (HSVE) is a rare complication of neurosurgical procedures and a significant clinical challenge Method We describe 3 cases of postoperative HSVE and review all published reports. A total of 23 cases were identified. Discussion Clinical heterogeneity represents a diagnostic challenge in the postoperative setting. Cerebral magnetic resonance imaging showed typical findings in a minority of patients only, whereas HSV-specific polymerase chain reaction on the cerebrospinal fluid proved to be a valuable test. The postoperative viral pathophysiology remains a subject of debate. The rate of adverse outcome is high and early antiviral treatment seems to be a strong predictor of clinical outcome. Conclusion We recommend early empirical treatment for any patient presenting with post-neurosurgical lymphocytic meningo-encephalitis, and prophylactic antiviral treatment for patients with a history of previous HSVE who will undergo a neurosurgical procedure.