Skip to main content

Advertisement

SpringerLink
Log in

HSV encephalitis in a child with brain stem glioma: a rare complication of therapy

Case report and review of the neurosurgical literature

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

Herpes simplex virus (HSV) encephalitis is a rare association with pediatric neurosurgical pathologies.

Case report

A 13-year-old boy was diagnosed with an inoperable, biopsy-proven pontine grade II astrocytoma. During radiotherapy, he developed status epilepticus controlled by thiopentone with intubation and ventilation. Empiric cefotaxime and aciclovir were given. Lumbar cerebrospinal fluid (CSF) showed a normal white cell count, normal glucose, and a slightly elevated protein level. However, the CSF showed a positive polymerase chain reaction (PCR) for HSV type 1 DNA. Intravenous aciclovir was given for 21 days and foscarnet for 7 days. He was extubated after 4 weeks at which time he was aphasic with spastic diplegia. After 8 weeks, MRI brain scan showed the typical bitemporal pattern of HSV encephalitis. He made slow improvement but died 8 months after diagnosis from tumor progression.

Conclusion

HSV encephalitis is a rare but life threatening complication in neurosurgical patients. A low threshold for both investigation with CSF PCR and empirical treatment with intravenous aciclovir is warranted. As in this case, initial microscopic examination of the CSF may be normal. The literature on HSV encephalitis in neurosurgical patients is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Boivin G (2004) Diagnosis of herpesvirus infections of the central nervous system. Herpes 11(Suppl 22):48A–56A

    PubMed  Google Scholar 

  2. Bourgeois M, Vinikoff L, Lellouch-Tubiana A, Sainte-Rose C (1999) Reactivation of herpes virus after surgery for epilepsy in a pediatric patient with mesial temporal sclerosis: case report. Neurosurgery 44(3):632–635

    Article  Google Scholar 

  3. De Tiege X, Heron B, Lebon P, Rozemberg F (2003) Limits of early diagnosis of herpes simplex encephalitis in children: a retrospective study of 38 cases. Clin Infect Dis 36(10):1335–1339

    Article  PubMed  Google Scholar 

  4. Domingues RB, Lakeman FD, Mayo MS, Whitley RJ (1998) Application of competitive PCR to cerebrospinal fluid samples from patients with herpes simplex encephalitis. J Clin Microbiol 36:2229–2234

    PubMed  CAS  Google Scholar 

  5. Fearnside MR, Grant JMF (1972) Acute necrotizing encephalitis complicating bifrontal craniotomy and pituitary curettage. J Neurosurg 36:499–502

    PubMed  CAS  Google Scholar 

  6. Koelfen W, Freund M, Giickel E, Rohr H, Schultze C (1996) MRI of encephalitis in children: comparison of CT and MRI in the acute stage with long-term follow-up. Neuroradiology 34:490–493

    Google Scholar 

  7. Pevenstein SR, Williams RK, McChesney D, Mont EK, Smialek JE, Strauss SE (1999) Quantitation of latent varicella-zoster virus and herpes simplex virus genome in human trigeminal ganglia. J Virol 12:10514–10518

    Google Scholar 

  8. Riel-Romero RMS, Baumann RJ (2003) Herpes simplex encephalitis and radiotherapy. Pediatr Neurol 29(1):69–71

    Article  PubMed  Google Scholar 

  9. Schiff D, Rosenblum MK (1998) Herpes simplex encephalitis (HSE) and the immunocompromised: a clinical and autoptical study of HSE in the settings of cancer and immunodeficiency virus-type 1 infection. Human Pathol 29:215–222

    Article  CAS  Google Scholar 

  10. Spuler A, Blaszyk H, Parisi JE, Davis DH (1999) Herpes simplex encephalitis after brain surgery: case report and review of the literature. J Neurol Neurosurg Psychiatry 67:239–242

    Article  PubMed  CAS  Google Scholar 

  11. Tyler LK (2004) Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret’s. Herpes 11(Suppl 2):57A–64A

    PubMed  Google Scholar 

  12. Tohyama Y, Sako K, Daita G, Yonemasu Y, Shuke N, Aburano T (1997) Dissociation of 99mTc-ECD and 99mTc-HMPAO distributions in herpes simplex encephalitis. Child’s Nerv Syst 13:352–355

    Article  CAS  Google Scholar 

  13. Whitley RJ (2006) Herpes simplex encephalitis: Adolescents and adults. Antiviral Res 71(2–3):141–148

    Article  PubMed  CAS  Google Scholar 

  14. Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, Hanley D, Nahmias AJ, Soong SJ (1986) Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 314(3):144–149

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Royal Liverpool Children’s Hospital NHS Trust, Liverpool, UK

    Barbara Spacca & Conor Mallucci

  2. Department of Infectious Diseases, Royal Liverpool Children’s Hospital NHS Trust, Liverpool, UK

    Andrew Riordan

  3. The Roald Dahl EEG Department, Paediatric Neurosciences Foundation, Royal Liverpool Children’s Hospital NHS Trust, Liverpool, UK

    Richard Appleton

  4. Clatterbridge Centre for Oncology, Bebington, Wirral, UK

    Nicky Thorp

  5. Department of Oncology, Royal Liverpool Children’s Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK

    Barry Pizer

Authors
  1. Barbara Spacca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Conor Mallucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew Riordan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Appleton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicky Thorp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barry Pizer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barry Pizer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spacca, B., Mallucci, C., Riordan, A. et al. HSV encephalitis in a child with brain stem glioma: a rare complication of therapy. Childs Nerv Syst 23, 1347–1350 (2007). https://doi.org/10.1007/s00381-007-0389-3

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-007-0389-3

Keywords

Search

Navigation