Herpes simplex encephalitis following microvascular decompression for trigeminal neuralgia

Case report

Hon Tang M.B.B.S., Francisco Falcone M.B.B.S., and Sam Eljamel M.B.B.Ch., M.D., F.R.C.S.(Ed), F.R.C.S.(Ir), F.R.C.S.(SN)
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  • Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, United Kingdom
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The authors present the first reported case of herpes simplex encephalitis (HSE) precipitated by trigeminal nerve microvascular decompression (MVD). The presentation of this specific case together with the pathogenesis and management of HSE are discussed, with a relevant literature review.

This 29-year-old woman with treatment-resistant trigeminal neuralgia underwent a successful elective MVD of the right trigeminal nerve. She was discharged but was readmitted 1 week postoperatively with clinical signs and symptoms of meningitis. A CSF sample was obtained through lumbar puncture before she was treated initially with ceftriaxone. The polymerase chain reaction test of CSF was later positive for herpes simplex virus Type 1, at which point the patient was switched to a 2-week course of intravenous acyclovir before being discharged.

Although this disease is rare, to avoid a delay in antiviral treatment the authors suggest that HSE should be considered in any patient presenting with a meningoencephalitic picture following MVD.

Abbreviations used in this paper:EEG = electroencephalography; HSE = herpes simplex encephalitis; HSV-1 = herpes simplex virus Type 1; LP = lumbar puncture; MVD = microvascular decompression; PCR = polymerase chain reaction; TN = trigeminal nerve.

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Contributor Notes

Address correspondence to: Sam Eljamel, M.B.B.Ch., M.D., Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom. email: m.s.eljamel@dundee.ac.uk.

Please include this information when citing this paper: published online January 4, 2013; DOI: 10.3171/2012.11.JNS121386.

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