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Abstract
After establishing latent infection, some viruses can be reactivated by the alteration of host immunological conditions. First, we reviewed viruses that can cause neuronal damage by reactivation. Then we focused on the herpes simplex virus (HSV). The reactivation leads to neuronal damages through two possible mechanisms; "reactivation of a latent herpes virus" by which viruses can cause direct virus neurotoxicity, and "post-infectious immune inflammatory response" by which a focal reactivation of HSV leads to an inflammatory reaction. The former is radiologically characterized by cortical lesions, the latter is characterized by subcortical white matter lesions. We experienced a female, who underwent the right posterior quadrantectomy and then developed recurrent herpes encephalitis caused by herpes simplex reactivation, which pathologically demonstrated inflammation in the white matter, suggesting a post-infectious immune inflammatory response. The patient was successfully treated with immunosuppressants. The reactivation of the HSV is extremely rare in Japan. Neurologists should recognize this condition because this disorder will increase as epilepsy surgery gains more popularity.
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Affiliation(s)
- Tomoyo Shimada
- Department of Neurology, Juntendo University School of Medicine
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University School of Medicine
- Epilepsy Center, Juntendo University School of Medicine
| | - Yasushi Iimura
- Department of Neurosurgery, Juntendo University School of Medicine
- Epilepsy Center, Juntendo University School of Medicine
| | - Hidenori Sugano
- Department of Neurosurgery, Juntendo University School of Medicine
- Epilepsy Center, Juntendo University School of Medicine
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Johnson GW, Han RH, Gupta VP, Leuthardt EC. Delayed HSV-1 Encephalitis Relapse After Epilepsy Surgery: A Case Report. NEUROSURGERY OPEN 2022. [DOI: 10.1227/neuopn.0000000000000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Iimura Y, Sugano H, Ueda T, Matsuda S, Karagiozov K, Tsunemi T, Takanashi M, Shimada T, Maruyama S, Otsubo H. Relapse of Herpes Simplex Encephalitis by Epilepsy Surgery 35 Years after the First Infection: A Case Report and Literature Review. NMC Case Rep J 2022; 8:235-240. [PMID: 35079469 PMCID: PMC8769415 DOI: 10.2176/nmccrj.cr.2020-0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022] Open
Abstract
Late relapse of herpes simplex encephalitis (HSE) is defined as the recurrence of HSE more than 3 months after the initial exposure. The postoperative diagnosis of HSE following neurosurgery is complicated because the clinical presentation can mimic other common complications of neurosurgery. Cerebrospinal fluid polymerase chain reactions (CSF-PCR) is the gold standard for the diagnosis of HSE. We describe a case of late HSE relapse after epilepsy surgery in a patient who required a brain biopsy due to repeated negative CSF-PCR results. A 38-year-old woman had a history of HSE from the age of 3 years. She had intractable epilepsy from the age of 20 years and underwent right posterior quadrant disconnection (PQD) at the age of 38 years. Postoperatively, she had a right hemispheric intracerebral hemorrhage (ICH) and her consciousness was gradually worsening. Her consciousness improved after removal of the ICH. However, her consciousness gradually deteriorated again. Fluid-attenuated inversion recovery (FLAIR) revealed bilateral hyperintensity in the frontal lobes, including the white matter. CSF-PCR for herpes simplex virus (HSV) was performed twice, but yielded negative results. We performed a brain biopsy to target FLAIR hyperintensity in the right frontal lobe. PCR of the brain specimen was positive for HSV. Her consciousness improved with acyclovir, methylprednisolone, and cyclophosphamide. To our knowledge, this is a case of HSE induced by epilepsy surgery which had the longest duration until relapse after the initial HSE episode. A brain biopsy can be used to confirm the diagnosis of suspected HSE when CSF-PCR results are negative.
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Affiliation(s)
- Yasushi Iimura
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hidenori Sugano
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Shimpei Matsuda
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Taiji Tsunemi
- Department of Neurology, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Masashi Takanashi
- Department of Neurology, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Tomoyo Shimada
- Department of Neurology, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Shinsuke Maruyama
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
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Trakolis L, Naros G, Vougioukas V, Tatagiba M. Herpes simplex meningitis after vestibular schwannoma surgery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20146. [PMID: 36045937 PMCID: PMC9394175 DOI: 10.3171/case20146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Herpes is the most common cause of viral encephalitis in the young population. Herpes meningitis following brain surgery is very rare, however. Only a few cases are reported in the literature, and only one concerned an infection after vestibular schwannoma surgery. OBSERVATIONS The authors report a case of a 44-year-old patient who developed severe herpes meningitis a few days after removal of a large cystic vestibular schwannoma. LESSONS Herpes simplex virus meningitis following a posterior fossa surgery must be considered when patients develop atypical symptoms a few days after surgery.
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Affiliation(s)
- Leonidas Trakolis
- Department of Neurosurgery, Eberhardt Karls University, Tuebingen, Germany; and
| | - Georgios Naros
- Department of Neurosurgery, Eberhardt Karls University, Tuebingen, Germany; and
| | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhardt Karls University, Tuebingen, Germany; and
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McLaughlin DC, Achey RL, Geertman R, Grossman J. Herpes simplex reactivation following neurosurgery: case report and review of the literature. Neurosurg Focus 2020; 47:E9. [PMID: 31370030 DOI: 10.3171/2019.5.focus19281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
| | - Rebecca L Achey
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Geertman
- 1Department of Neurosurgery, MetroHealth Medical Center, Cleveland; and
| | - Jonah Grossman
- 1Department of Neurosurgery, MetroHealth Medical Center, Cleveland; and
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Zhang P, Yang Y, Zou J, Yang X, Liu Q, Chen Y. Seizures and epilepsy secondary to viral infection in the central nervous system. ACTA EPILEPTOLOGICA 2020. [DOI: 10.1186/s42494-020-00022-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AbstractViral infection in the central nervous system (CNS) is a common cause of seizures and epilepsy. Acute symptomatic seizures can occur in the context of almost all types of acute CNS viral infection. However, late unprovoked seizures and epilepsy may not be frequent after viral infection of the CNS. The incidence of seizures and epilepsy after CNS viral infection is mainly dependent on the brain region of infection. It remains to be determined whether treatment of CNS viral infection using antiepileptic drugs (AEDs) can prevent seizures and subsequent epilepsy in patients, particularly with regard to the timing, drug choice and dosage, and duration of AEDs. The postoperative outcome of seizures in patients with intractable epilepsy caused by viral encephalitis primarily depends on the epileptogenic zone. In addition, neuroinflammation is known to be widely involved in the generation of seizures during CNS viral infection, and the effects of anti-inflammatory therapies in preventing seizures and epilepsy secondary to CNS viral infection require further studies. In this review, we discuss the incidence, mechanisms, clinical management and prognosis of seizures and epilepsy secondary to CNS viral infection, and summarize common CNS viral infections that cause seizures and epilepsy.
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HSV-1 encephalitis relapse after epilepsy surgery: a case report and review of the literature. J Neurovirol 2019; 26:138-141. [PMID: 31468470 DOI: 10.1007/s13365-019-00796-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/23/2019] [Accepted: 08/16/2019] [Indexed: 12/25/2022]
Abstract
Herpes simplex encephalitis relapses have been rarely reported, with only few cases occurring after neurosurgical interventions. A young man presented a late herpes simplex encephalitis relapse after left antero-mesial temporal resection for his refractory temporal lobe epilepsy. Eight days after surgery, he developed fever and aphasia. CSF PCR revealed more than 12,000 copies/ml of HSV-1 DNA. Intravenous acyclovir was immediately started with a complete recovery. Postoperative herpes simplex encephalitis can occur as primary infection or as relapse of previous infection. Surgical manipulation of brain parenchyma in the site of a previous infection can act as a trigger for viral reactivation. Early onset of antiviral therapy is fundamental and it is a strong predictor of clinical outcome. Despite no studies on prophylactic treatment with acyclovir in patients with previous herpes simplex encephalitis candidate to neurosurgery are available, we suggest that prophylactic treatment should be recommended.
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Itzhaki RF. Corroboration of a Major Role for Herpes Simplex Virus Type 1 in Alzheimer's Disease. Front Aging Neurosci 2018; 10:324. [PMID: 30405395 PMCID: PMC6202583 DOI: 10.3389/fnagi.2018.00324] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023] Open
Abstract
Strong evidence has emerged recently for the concept that herpes simplex virus type 1 (HSV1) is a major risk for Alzheimer’s disease (AD). This concept proposes that latent HSV1 in brain of carriers of the type 4 allele of the apolipoprotein E gene (APOE-ε4) is reactivated intermittently by events such as immunosuppression, peripheral infection, and inflammation, the consequent damage accumulating, and culminating eventually in the development of AD. Population data to investigate this epidemiologically, e.g., to find if subjects treated with antivirals might be protected from developing dementia—are available in Taiwan, from the National Health Insurance Research Database, in which 99.9% of the population has been enrolled. This is being extensively mined for information on microbial infections and disease. Three publications have now appeared describing data on the development of senile dementia (SD), and the treatment of those with marked overt signs of disease caused by varicella zoster virus (VZV), or by HSV. The striking results show that the risk of SD is much greater in those who are HSV-seropositive than in seronegative subjects, and that antiviral treatment causes a dramatic decrease in number of subjects who later develop SD. It should be stressed that these results apply only to those with severe cases of HSV1 or VZV infection, but when considered with the over 150 publications that strongly support an HSV1 role in AD, they greatly justify usage of antiherpes antivirals to treat AD. Three other studies are described which directly relate to HSV1 and AD: they deal respectively with lysosomal changes in HSV1-infected cell cultures, with evidence for a role of human herpes virus type 6 and 7 (HHV6 and HHV7) in AD, and viral effects on host gene expression, and with the antiviral characteristics of beta amyloid (Aβ). Three indirectly relevant studies deal respectively with schizophrenia, relating to antiviral treatment to target HSV1, with the likelihood that HSV1 is a cause of fibromyalgia (FM), and with FM being associated with later development of SD. Studies on the link between epilepsy, AD and herpes simplex encephalitis (HSE) are described also, as are the possible roles of APOE-ε4, HHV6 and HSV1 in epilepsy.
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Affiliation(s)
- Ruth F Itzhaki
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Valyi-Nagy T, Rathore JS, Rakic AM, Rathore RS, Jain P, Slavin KV. Herpes Simplex Virus Type 1 Human Cervical Dorsal Root Ganglionitis. Case Rep Neurol 2017; 9:188-194. [PMID: 28966586 PMCID: PMC5618399 DOI: 10.1159/000479146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/29/2017] [Indexed: 01/20/2023] Open
Abstract
We present a case of a 34-year-old right-handed Caucasian male with chronic occipital neuralgia refractory to medical therapies and minimally invasive pain procedures who underwent surgical cervical dorsal root ganglionectomy which completely relieved his headaches. The histopathological and immunohistochemical findings of the resected cervical dorsal root ganglia were consistent with active herpes simplex virus type 1 (HSV-1) infection causing ganglionitis. To the best of our knowledge, this case represents the first histopathologically proven HSV-1 cervical dorsal root ganglionitis in humans. This case provides an insight into a possible etiology of occipital neuralgia.
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Affiliation(s)
- Tibor Valyi-Nagy
- Department of Pathology, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA.,Neuropsychiatric Institute, Department of Neurology and Rehabilitation, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA.,Department of Neurosurgery, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA
| | - Jaivir S Rathore
- Neuropsychiatric Institute, Department of Neurology and Rehabilitation, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA
| | - Andrei M Rakic
- Department of Anesthesiology, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA
| | - Ranvir S Rathore
- Department of Internal Medicine, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
| | - Paavani Jain
- Department of Pathology, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois School of Medicine at Chicago, Chicago, Illinois, USA
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Jaques DA, Bagetakou S, L'Huillier AG, Bartoli A, Vargas MI, Fluss J, Kaiser L. Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature. Virol J 2016; 13:83. [PMID: 27216026 PMCID: PMC4877812 DOI: 10.1186/s12985-016-0540-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- David A Jaques
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Spyridoula Bagetakou
- Division of General Pediatrics, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Andrea Bartoli
- Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | | | - Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialties Service, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- University of Geneva Medical School, Geneva, Switzerland.
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Álvarez de Eulate-Beramendi S, Santirso-Rodríguez D, Piña-Batista K, Gutiérrez-Morales J. Herpes simplex virus type 1 encephalitis after meningioma resection. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Lo Presti A, Weil AG, Niazi TN, Bhatia S. Herpes simplex reactivation or postinfectious inflammatory response after epilepsy surgery: Case report and review of the literature. Surg Neurol Int 2015; 6:47. [PMID: 25883839 PMCID: PMC4392527 DOI: 10.4103/2152-7806.153882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 12/09/2014] [Indexed: 12/22/2022] Open
Abstract
Background: Herpes simplex virus encephalitis (HSVE) is the most morbid clinical syndrome associated with the human herpes virus. Despite treatment with appropriate dosages of acyclovir, neurologic relapse of HSV infection have been reported after cranial surgery. Rarely, neurological deterioration due to postinfectious inflammatory response without demonstrable HSV reactivation may recur following cranial surgery. Case Description: We report a case of a 17-year-old girl who presented with a HSVE relapse on the 6th postoperative day following resective surgery for medically refractory epilepsy and review the literature. Postinfectious inflammatory reaction may be the underlying mechanism in cases with no HSV identified on cerebrospinal fluid (CSF) or brain polymerase chain reaction (PCR), such as in the current case. Conclusion: HSVE must be suspected in patients with previous history of HSVE and postoperative fever associated with an altered state of consciousness and/or seizures. Considering the high mortality and morbidity rates associated with HSVE, an adequate prophylactic administration of acyclovir should be considered for patients with previous history of HSVE undergoing neurosurgical procedures, especially when surgery involves the site of a previous herpetic lesion.
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Affiliation(s)
- Anna Lo Presti
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, Miami, FL, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, Miami, FL, USA
| | - Toba N Niazi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, Miami, FL, USA
| | - Sanjiv Bhatia
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, Miami, FL, USA
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Álvarez de Eulate-Beramendi S, Santirso-Rodríguez D, Piña-Batista KM, Gutiérrez-Morales JC. Herpes simplex virus type 1 encephalitis after meningioma resection. Neurologia 2014; 30:455-7. [PMID: 24792498 DOI: 10.1016/j.nrl.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/01/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - K M Piña-Batista
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - J C Gutiérrez-Morales
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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A case of late herpes simplex encephalitis relapse. J Clin Virol 2013; 58:269-70. [DOI: 10.1016/j.jcv.2013.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/14/2013] [Indexed: 11/18/2022]
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