title: Herpes simplex encephalitis following microvascular decompression for trigeminal neuralgia.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.
authors.forename: Hon
authors.initials: H
authors.lastname: Tang
authors.forename: Francisco
authors.initials: F
authors.lastname: Falcone
authors.forename: Sam
authors.initials: S
authors.lastname: Eljamel
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000821:virology; D004569:Electroencephalography; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D061145:Microvascular Decompression Surgery / Q000009:adverse effects*; D013129:Spinal Puncture; D014277:Trigeminal Neuralgia / Q000601:surgery*
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir