title: Herpes simplex meningitis after removal of a vestibular schwannoma:  case report and review of the literature.
abstract: OBJECTIVE
  We present a case of postoperative herpes simplex type 1 viral meningitis after retrosigmoid craniotomy and uncomplicated removal of a vestibular schwannoma. This is a very rare complication that can mimic aseptic meningitis and could lead to devastating consequences for the patient, if unrecognized.
  
  
  METHODS
  A healthy 49-year-old woman underwent retrosigmoid craniotomy and resection of a 2.4-cm vestibular schwannoma. She developed worsening headache and low-grade fever on postoperative Day 10 and underwent lumbar puncture showing a lymphocyte predominant pleocytosis. Polymerase chain reaction was positive for herpes simplex type 1 virus; bacterial cultures were negative. The patient subsequently developed a pseudomeningocele and mild hydrocephalus.
  
  
  METHODS
  The patient was readmitted to the hospital, started on corticosteroids, and a lumbar drain was placed. She completed a 14-day course of antiviral therapy (4 d intravenous as an inpatient and 10 d oral outpatient therapy).
  
  
  RESULTS
  At 1 month follow-up, she was completely asymptomatic, and her pseudomeningocele had resolved.
  
  
  CONCLUSIONS
  The diagnosis of herpes simplex viral meningitis should be suspected in clinical cases of postsurgical meningitis with a lymphocyte predominant pleocytosis and negative bacterial cultures. Antiviral therapy should be initiated immediately after confirmatory polymerase chain reaction testing to avoid potential long-term sequelae of a herpes simplex infection of the central nervous system.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Mallory
authors.forename: John W
authors.initials: JW
authors.lastname: Wilson
authors.forename: Marina L
authors.initials: ML
authors.lastname: Castner
authors.forename: Colin L W
authors.initials: CL
authors.lastname: Driscoll
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001299:Audiometry; D003399:Craniotomy; D005260:Female; D006261:Headache / Q000209:etiology; D034381:Hearing Loss / Q000209:etiology; D006561:Herpes Simplex / Q000209:etiology* / Q000473:pathology / Q000821:virology; D018259:Herpesvirus 1, Human; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008587:Meningitis, Viral / Q000209:etiology* / Q000473:pathology / Q000821:virology; D008588:Meningocele / Q000209:etiology; D008875:Middle Aged; D009460:Neurologic Examination; D009464:Neuroma, Acoustic / Q000601:surgery*; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology
chemical_list: D000998:Antiviral Agents