Herpes simplex meningitis after removal of a vestibular schwannoma

Case report and review of the literature

Grant W. Mallory, John W. Wilson, Marina L. Castner, Colin L.W. Driscoll, Michael J. Link

Research output: Contribution to journalReview article

3 Citations (Scopus)

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. PATIENT: 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. INTERVENTION: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1422-1425
Number of pages4
JournalOtology and Neurotology
Volume33
Issue number8
DOIs
StatePublished - Oct 2012

Fingerprint

Herpes Simplex
Acoustic Neuroma
Viral Meningitis
Meningitis
Craniotomy
Leukocytosis
Antiviral Agents
Lymphocytes
Aseptic Meningitis
Central Nervous System Infections
Polymerase Chain Reaction
Spinal Puncture
Human Herpesvirus 1
Hydrocephalus
Headache
Inpatients
Adrenal Cortex Hormones
Fever
Outpatients
Therapeutics

Keywords

  • Craniotomy
  • Herpes simplex virus
  • Infection
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

Herpes simplex meningitis after removal of a vestibular schwannoma : Case report and review of the literature. / Mallory, Grant W.; Wilson, John W.; Castner, Marina L.; Driscoll, Colin L.W.; Link, Michael J.

In: Otology and Neurotology, Vol. 33, No. 8, 10.2012, p. 1422-1425.

Research output: Contribution to journalReview article

Mallory, Grant W. ; Wilson, John W. ; Castner, Marina L. ; Driscoll, Colin L.W. ; Link, Michael J. / Herpes simplex meningitis after removal of a vestibular schwannoma : Case report and review of the literature. In: Otology and Neurotology. 2012 ; Vol. 33, No. 8. pp. 1422-1425.
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AB - 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. PATIENT: 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. INTERVENTION: 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. Conclusion: 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.

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