Távora-Vieira Dayse, Miller Stuart
Cochlear Implants Int. 2014 Mar;15(2):118-20. doi: 10.1179/1754762813Y.0000000047. Epub 2013 Nov 25.
Herpes simplex virus (HSV) is reported to be the most common cause of viral encephalitis. Although extremely rare, reactivation of the virus has been reported following central nervous system surgery. To the best of our knowledge, there is no report in the literature that describes HSV encephalitis following cochlear implantation.
We report a case of meningo-encephalitis occurring 17 days after cochlear implantation using an electro-acoustic stimulation device, with oerioperative steroid medication. Intensive anti-viral therapy was given and the patient recovered from the acute illness over 2 weeks. Agitation and anxiety followed the encephalitis and subsequent progress with the cochlear implant was slow. Twelve months after cochlear implantation this patient shows a gradual and steady progress with her hearing rehabilitation.
Cochlear implantation surgery was either coincidental or was the trigger factor for reactivation of the HSV. Surgeons must be vigilant to post-surgical meningism symptoms particularly if patients have a history of herpes infections.
据报道，单纯疱疹病毒（HSV）是病毒性脑炎最常见的病因。尽管极为罕见，但中枢神经系统手术后病毒再激活的情况已有报道。据我们所知，文献中尚无关于人工耳蜗植入术后发生HSV脑炎的报道。
我们报告1例使用电声刺激装置进行人工耳蜗植入术后17天发生的脑膜脑炎病例，术中使用了类固醇药物。给予了强化抗病毒治疗，患者在2周内从急性病中康复。脑炎后出现躁动和焦虑，随后人工耳蜗植入的进展缓慢。人工耳蜗植入12个月后，该患者的听力康复逐渐稳步进展。
人工耳蜗植入手术要么是巧合，要么是HSV再激活的触发因素。外科医生必须警惕术后的脑膜刺激症状，特别是当患者有疱疹感染史时。
