Herpes simplex encephalitis and bilateral acute retinal necrosis syndrome after craniotomy.
OBJECTIVE
Acute retinal necrosis (ARN) syndrome is associated with members of the herpes virus family, but the mechanisms of infection remain unclear. The purpose of this study is to report a unique case of acute retinal necrosis syndrome associated with herpetic encephalitis in order to elucidate possible factors involved in herpetic central nervous system disease.


METHODS
Case report.


RESULTS
A 64-year-old woman who developed acute herpes simplex virus encephalitis associated with bilateral acute retinal necrosis syndrome after craniotomy for resection of a suprasellar craniopharyngioma is presented. The results of lumbar puncture, magnetic resonance imaging, and ophthalmologic examination are consistent with herpetic infection. The origin of acute retinal necrosis syndrome and the association of acute retinal necrosis syndrome with encephalitis are reviewed.


CONCLUSIONS
After craniotomy, we hypothesize reactivation of previously latent herpes simplex virus in the area of the inferior frontal lobe and optic chiasm. Reactivated virus may have migrated to the retina by axonal transport, through the optic nerves, to produce the acute retinal necrosis syndrome.
Perry
J D
JD
Department of Ophthalmology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Girkin
C A
CA
Miller
N R
NR
Kerr
D A
DA
D000212:Acyclovir / Q000627:therapeutic use; D001370:Axonal Transport; D002555:Cerebrospinal Fluid / Q000821:virology; D003397:Craniopharyngioma / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects*; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015828:Eye Infections, Viral / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009900:Optic Nerve / Q000821:virology; D010911:Pituitary Neoplasms / Q000601:surgery; D015882:Retinal Necrosis Syndrome, Acute / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D013129:Spinal Puncture; D014775:Virus Activation; D017735:Virus Latency
D000212:Acyclovir