Abstract
OBJECTIVE: To characterize the incidence, diagnostic and therapeutic trends and raise awareness of cases of Herpes Simplex Encephalitis occurring within 30 days after neurosurgery for CNS tumors. METHOD: Literature search for cases meeting above criteria and meta-analysis of data. RESULTS: 18 cases were studied. The most common tumor was meningitis. Encephalopathy, fever and seizure were the most common presenting symptoms (94%, 83% and 50 % respectively). 50% of cases had HSV-1, 22% had HSV-2, while 28% were unspecified. A majority of the patients (78%) received in acyclovir, with a 79% survival rate with treatment. Mortality rate was 100% without acyclovir treatment. Median time of starting acyclovir was 17 days. Most patients received steroids (78%) but steroids was not associated with a specific outcome. CONCLUSION: Herpes simplex Encephalitis should be suspected after neurosurgery for tumors in patients with fever, encephalopathy or seizures and should be promptly treated with iv acyclovir. A delay in recognition and failure to treat could result in severe morbidity and mortality. In our study steroid use was not associated with improved outcome but larger studies are needed.