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01.12.2016 | Case Report | Ausgabe 1/2016 Open Access

Virology Journal 1/2016

Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature

Virology Journal > Ausgabe 1/2016
David A. Jaques, Spyridoula Bagetakou, Arnaud G. L’Huillier, Andrea Bartoli, Maria-Isabel Vargas, Joel Fluss, Laurent Kaiser



Herpes simplex virus (HSV) is the most common identified cause of focal encephalitis worldwide. However, postoperative HSV encephalitis (HSVE) is a rare complication of neurosurgical procedures and a significant clinical challenge


We describe 3 cases of postoperative HSVE and review all published reports. A total of 23 cases were identified.


Clinical heterogeneity represents a diagnostic challenge in the postoperative setting. Cerebral magnetic resonance imaging showed typical findings in a minority of patients only, whereas HSV-specific polymerase chain reaction on the cerebrospinal fluid proved to be a valuable test. The postoperative viral pathophysiology remains a subject of debate. The rate of adverse outcome is high and early antiviral treatment seems to be a strong predictor of clinical outcome.


We recommend early empirical treatment for any patient presenting with post-neurosurgical lymphocytic meningo-encephalitis, and prophylactic antiviral treatment for patients with a history of previous HSVE who will undergo a neurosurgical procedure.
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