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Reactivation of herpes simplex virus-1 following epilepsy surgery.

de Almeida SM, Crippa A, Cruz C, de Paola L, de Souza LP, Noronha L, Torres LF, Koneski JA, Pessa LF, Nogueira MB, Raboni SM, Silvado CE, Vidal LR - Epilepsy Behav Case Rep (2015)

Bottom Line: She had meningoencephalitis due to HSV at the age of 20 months, and she was treated with acyclovir.She was treated with acyclovir (30 mg/kg/day for 21 days).The authors stress the potential risk of reactivation of HSV encephalitis after intracranial surgery.

View Article: PubMed Central - PubMed

Affiliation: Laboratório de Virologia, 1-4 Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil ; Instituto de Pesquisa Pelé Pequeno Príncipe & Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.

ABSTRACT

Purpose: The present study reports a case of encephalitis due to herpes simplex virus-1 (HSV-1), following surgical manipulation of the site of a primary infection.

Methods: Herpes simplex virus-1 infection was confirmed by CSF PCR and DNA sequencing.

Results: The patient was an 11-year-old girl who required temporal lobe surgery for epilepsy. She had meningoencephalitis due to HSV at the age of 20 months, and she was treated with acyclovir. Three years later, the patient developed uncontrolled seizures that became more frequent and changed in character at 11 years of age. On the 12th postoperative day, she developed fever and seizures, and she was diagnosed with HSV-1 by positive CSF PCR. She was treated with acyclovir (30 mg/kg/day for 21 days). In this report, we describe the patient and review the relevant literature.

Conclusion: The authors stress the potential risk of reactivation of HSV encephalitis after intracranial surgery. Herpes simplex virus encephalitis must be considered in neurosurgical patients who develop postoperative seizures and fever.

No MeSH data available.


Related in: MedlinePlus

MRI image, coronal, FLAIR (fluid acquisition inversion recovery) sequence. TR: 11,000 ms; TE: 140 ms; FOV: 220 mm2. Showing sequelae: area of hyperintense signal, with cavitations, volumetric loss, and disruption of brain parenchyma.
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f0010: MRI image, coronal, FLAIR (fluid acquisition inversion recovery) sequence. TR: 11,000 ms; TE: 140 ms; FOV: 220 mm2. Showing sequelae: area of hyperintense signal, with cavitations, volumetric loss, and disruption of brain parenchyma.

Mentions: On the 12th POD, the patient developed fever (39–40 °C) and severe headache, vomiting, and had deteriorating level of consciousness and worsening of general condition. Neurological examination results were as follows: sleepiness although obeying commands, Glasgow coma scale score of 14/15 (eye opening: 4, verbal response: 4, and motor response: 6), pupils bilaterally isochoric and reactive to light, neck stiffness, and spontaneous respiration. An infectious workup, including lumbar puncture (Table 1) and blood and urine cultures, identified no bacteria or fungus. Acyclovir was administered intravenously (15 mg/kg/dose) for 21 days. Magnetic resonance imaging (MRI) showed sequelae with hyperintense signal, cavitations, volume loss, and disruption of brain parenchyma (Fig. 2). Cerebrospinal fluid (CSF) analyzed by end-point PCR was positive for HSV and negative for enterovirus (Table 1). Herpes simplex virus-1 was identified using sequencing of DNA polymerase UL30. The patient was discharged from the hospital with no clinical or EEG evidence of seizures and was on the following antiepileptic drugs: divalproex sodium (13.5 mg/kg/day; TID), carbamazepine (15 mg/kg/day; TID), and clobazam (0.25 mg/kg/day; once daily).


Reactivation of herpes simplex virus-1 following epilepsy surgery.

de Almeida SM, Crippa A, Cruz C, de Paola L, de Souza LP, Noronha L, Torres LF, Koneski JA, Pessa LF, Nogueira MB, Raboni SM, Silvado CE, Vidal LR - Epilepsy Behav Case Rep (2015)

MRI image, coronal, FLAIR (fluid acquisition inversion recovery) sequence. TR: 11,000 ms; TE: 140 ms; FOV: 220 mm2. Showing sequelae: area of hyperintense signal, with cavitations, volumetric loss, and disruption of brain parenchyma.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556748&req=5

f0010: MRI image, coronal, FLAIR (fluid acquisition inversion recovery) sequence. TR: 11,000 ms; TE: 140 ms; FOV: 220 mm2. Showing sequelae: area of hyperintense signal, with cavitations, volumetric loss, and disruption of brain parenchyma.
Mentions: On the 12th POD, the patient developed fever (39–40 °C) and severe headache, vomiting, and had deteriorating level of consciousness and worsening of general condition. Neurological examination results were as follows: sleepiness although obeying commands, Glasgow coma scale score of 14/15 (eye opening: 4, verbal response: 4, and motor response: 6), pupils bilaterally isochoric and reactive to light, neck stiffness, and spontaneous respiration. An infectious workup, including lumbar puncture (Table 1) and blood and urine cultures, identified no bacteria or fungus. Acyclovir was administered intravenously (15 mg/kg/dose) for 21 days. Magnetic resonance imaging (MRI) showed sequelae with hyperintense signal, cavitations, volume loss, and disruption of brain parenchyma (Fig. 2). Cerebrospinal fluid (CSF) analyzed by end-point PCR was positive for HSV and negative for enterovirus (Table 1). Herpes simplex virus-1 was identified using sequencing of DNA polymerase UL30. The patient was discharged from the hospital with no clinical or EEG evidence of seizures and was on the following antiepileptic drugs: divalproex sodium (13.5 mg/kg/day; TID), carbamazepine (15 mg/kg/day; TID), and clobazam (0.25 mg/kg/day; once daily).

Bottom Line: She had meningoencephalitis due to HSV at the age of 20 months, and she was treated with acyclovir.She was treated with acyclovir (30 mg/kg/day for 21 days).The authors stress the potential risk of reactivation of HSV encephalitis after intracranial surgery.

View Article: PubMed Central - PubMed

Affiliation: Laboratório de Virologia, 1-4 Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil ; Instituto de Pesquisa Pelé Pequeno Príncipe & Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.

ABSTRACT

Purpose: The present study reports a case of encephalitis due to herpes simplex virus-1 (HSV-1), following surgical manipulation of the site of a primary infection.

Methods: Herpes simplex virus-1 infection was confirmed by CSF PCR and DNA sequencing.

Results: The patient was an 11-year-old girl who required temporal lobe surgery for epilepsy. She had meningoencephalitis due to HSV at the age of 20 months, and she was treated with acyclovir. Three years later, the patient developed uncontrolled seizures that became more frequent and changed in character at 11 years of age. On the 12th postoperative day, she developed fever and seizures, and she was diagnosed with HSV-1 by positive CSF PCR. She was treated with acyclovir (30 mg/kg/day for 21 days). In this report, we describe the patient and review the relevant literature.

Conclusion: The authors stress the potential risk of reactivation of HSV encephalitis after intracranial surgery. Herpes simplex virus encephalitis must be considered in neurosurgical patients who develop postoperative seizures and fever.

No MeSH data available.


Related in: MedlinePlus