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

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)

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