acyclovir and Brain-Stem-Neoplasms

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

Topics: Acyclovir; Adolescent; Antiviral Agents; Astrocytoma; Brain Stem Neoplasms; Encephalitis, Herpes Simplex; Fatal Outcome; Herpesvirus 1, Human; Humans; Male; Radiotherapy

Topics: Acyclovir; Antineoplastic Agents, Alkylating; Antiviral Agents; Brain Stem Neoplasms; Cognitive Dysfunction; Cranial Irradiation; Dacarbazine; Delirium; Dexamethasone; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Glioma; Herpesvirus 1, Human; Humans; Leukocytosis; Magnetic Resonance Imaging; Seizures; Temozolomide; Young Adult

Herpes virus encephalitis is a rare, life-threatening complication of therapy in patients with brain tumors. A surgical therapeutic approach may be needed because the infection can be resistant to acyclovir in immunocompromised patients, and complications and long-term sequelae are frequent.. We present the case of a right-handed, 6-year-old girl with a brainstem tumor who had herpes virus encephalitis with refractory seizures while on immunosuppressive treatment. The virus was resistant to acyclovir but responded to gancyclovir. The patient developed local refractory brain edema with right uncal herniation.. To reduce the intracranial pressure, internal decompressive craniotomy was performed, which consisted of a right temporal lobectomy that allowed us to remove the focal necrotic-hemorrhagic tissue, decrease inflammation, and avoid subsequent chronic gliotic scarring. Clinical improvement was clear with prompt recovery and acute control of seizures. The only remaining deficits were mild memory and attention impairments. Seizures did not recur in the next 6 months.. Antiviral resistance should be suspected in immunocompromised patients with herpes virus encephalitis if there is no early response to acyclovir. If uncal herniation of the nondominant temporal lobe develops, temporal lobectomy, as an internal decompressive procedure, can be lifesaving. Lobectomy stopped the acute refractory seizures and can be considered a good approach to prevent later epilepsy, with only mild residual cognitive deficits.

Topics: Acyclovir; Anterior Temporal Lobectomy; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Brain Stem Neoplasms; Child; Electroencephalography; Encephalitis, Herpes Simplex; Female; Humans; Magnetic Resonance Imaging; Radiotherapy; Seizures; Temporal Lobe