Post-operative Herpes simplex virus encephalitis after surgical resection of acoustic neuroma: a case report

Herpes simplex virus (HSV) encephalitis is a life-threatening consequence of HSV infection of the central nervous system. Although HSV encephalitis is rare, mortality rates reach 70 per cent in the absence of therapy and only a minority of individuals return to normal function. Antiviral therapy is...

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Bibliographic Details
Published in:Journal of laryngology and otology 2005-07, Vol.119 (7), p.558-560
Main Authors: Filipo, Roberto, Attanasio, Giuseppe, De Seta, Elio, Viccaro, Marika
Format: Article
Language:English
Subjects:
(RF) Otorhinolaryngology
Acoustic Neuroma
Adult
Biological and medical sciences
Corpus Callosum - pathology
Diffusion Magnetic Resonance Imaging - methods
DNA, Viral - analysis
Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology
Encephalitis
Encephalitis, Herpes Simplex - etiology
Encephalitis, Herpes Simplex - pathology
Herpes Simplex
Human viral diseases
Humans
Infectious diseases
Male
Medical sciences
Neuroma, Acoustic - pathology
Neuroma, Acoustic - surgery
Otorhinolaryngology. Stomatology
Postoperative Complications - etiology
Postoperative Complications - pathology
Tumors
Viral diseases
Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
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Summary:Herpes simplex virus (HSV) encephalitis is a life-threatening consequence of HSV infection of the central nervous system. Although HSV encephalitis is rare, mortality rates reach 70 per cent in the absence of therapy and only a minority of individuals return to normal function. Antiviral therapy is most effective when started early, necessitating prompt diagnosis. A case of atypical HSV encephalitis is reported. The appearance of a strong headache followed by impairment of consciousness and hypertone of arms and legs complicated the post-operative course in a 33-year-old patient who underwent surgical removal of an acoustic neuroma. Several brain magnetic resonance imaging (MRI) and computed tomography scans performed in the first week after onset of symptoms of infection did not establish a proper diagnosis. Diffusion-weighted MRI detected brain abnormalities on the fourth day after onset of symptoms, and polymerase chain reaction identification of HSV 1 DNA confirmed the diagnosis. A positive prognosis was achieved due to the decision to start specific, high-dose antiviral therapy based on clinical suspicion, before a firm diagnosis was established.
ISSN:0022-2151
1748-5460
DOI:10.1258/0022215054352243