Herpes simplex encephalitis and bilateral acute retinal necrosis syndrome after craniotomy

Am J Ophthalmol. 1998 Sep;126(3):456-60. doi: 10.1016/s0002-9394(98)00108-1.


Purpose: Acute retinal necrosis (ARN) syndrome is associated with members of the herpes virus family, but the mechanisms of infection remain unclear. The purpose of this study is to report a unique case of acute retinal necrosis syndrome associated with herpetic encephalitis in order to elucidate possible factors involved in herpetic central nervous system disease.

Method: Case report.

Results: A 64-year-old woman who developed acute herpes simplex virus encephalitis associated with bilateral acute retinal necrosis syndrome after craniotomy for resection of a suprasellar craniopharyngioma is presented. The results of lumbar puncture, magnetic resonance imaging, and ophthalmologic examination are consistent with herpetic infection. The origin of acute retinal necrosis syndrome and the association of acute retinal necrosis syndrome with encephalitis are reviewed.

Conclusions: After craniotomy, we hypothesize reactivation of previously latent herpes simplex virus in the area of the inferior frontal lobe and optic chiasm. Reactivated virus may have migrated to the retina by axonal transport, through the optic nerves, to produce the acute retinal necrosis syndrome.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use
  • Axonal Transport
  • Cerebrospinal Fluid / virology
  • Craniopharyngioma / surgery
  • Craniotomy / adverse effects*
  • Encephalitis, Viral / diagnosis
  • Encephalitis, Viral / drug therapy
  • Encephalitis, Viral / etiology*
  • Eye Infections, Viral* / drug therapy
  • Eye Infections, Viral* / pathology
  • Female
  • Herpes Simplex / diagnosis
  • Herpes Simplex / drug therapy
  • Herpes Simplex / etiology*
  • Herpesvirus 2, Human / isolation & purification
  • Herpesvirus 2, Human / physiology
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Optic Nerve / virology
  • Pituitary Neoplasms / surgery
  • Retinal Necrosis Syndrome, Acute / drug therapy
  • Retinal Necrosis Syndrome, Acute / pathology
  • Retinal Necrosis Syndrome, Acute / virology*
  • Spinal Puncture
  • Virus Activation
  • Virus Latency


  • Acyclovir