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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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Delayed recurrence of neonatal HSV-2 encephalitis after 21 years, complicated by ischemic stroke: a case report. Neurol Sci 2021; 42:2991-2994. [PMID: 33638723 DOI: 10.1007/s10072-021-05131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
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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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Management and results of epilepsy surgery associated with acyclovir prophylaxis in four pediatric patients with drug-resistant epilepsy due to herpetic encephalitis and review of the literature. Eur J Paediatr Neurol 2020; 29:128-136. [PMID: 32868196 DOI: 10.1016/j.ejpn.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/30/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Herpes simplex virus encephalitis (HSE) is the most common cause of sporadic viral encephalitis in children and is responsible for epilepsy in approximately half of patients. In addition to medical treatment, epilepsy surgery may be offered to drug-resistant patients but carries a high risk of relapse of herpetic encephalitis. We are reporting our series of patients operated on between 2000 and 2019 with the systematic administration of acyclovir (ACV). RESULTS Four pediatric patients aged 4.5-12.8 years with drug-resistant epilepsy post-HSE underwent a tailored focal resection following invasive recordings (three patients) and a complete callosotomy (one patient). The total number of the surgical procedures for the four patients was eight, and a systematic administration of ACV as a prophylactic treatment of herpetic encephalitis relapse was done at each step. No patients had a relapse and the ACV was well-tolerated in all the cases. Following surgery two patients are seizure free, the patient who underwent callosotomy is Engel 3 and the fourth patient, in whom a large epileptic zone has contraindicated a second surgery, is Engel 4. CONCLUSIONS Our series demonstrated the dramatic efficacy of systematic ACV prophylaxis during all cranial surgeries. Moreover, our results on epilepsy, together with those of the literature, encourage more consideration regarding epilepsy surgery in this specific etiology. All types of surgical procedures (curative or palliative) can be offered to the patients, but in the case of focal surgery, due to the poor anatomical limits, invasive recordings are highly recommended.
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Martínez-Poles J, Toledano R, Aledo-Serrano Á, Korn K, Coras R, Blümcke I, García-Morales I, Álvarez-Linera J, Gil-Nagel A. Herpes simplex virus encephalitis after temporal lobe resection: an infrequent but treatable complication of epilepsy surgery. Eur J Neurol 2020; 27:e60-e61. [PMID: 32794613 DOI: 10.1111/ene.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- J Martínez-Poles
- Neurology Department, Hospital La Luz, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clinico San Carlos, Madrid, Spain
| | - R Toledano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Á Aledo-Serrano
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - K Korn
- Institute of Virology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - R Coras
- Institute of Neuropathology, University Hospitals, Erlangen, Germany
| | - I Blümcke
- Institute of Neuropathology, University Hospitals, Erlangen, Germany
| | - I García-Morales
- Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clinico San Carlos, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - J Álvarez-Linera
- Radiology Department, Hospital Ruber Internacional, Madrid, Spain
| | - A Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
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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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