An Unusual Case of Herpes Simplex Meningitis after Inadvertent Puncture of the Subarachnoid Space

作     者：Richell Bastos Vale Bruno Vítor Martins Santiago José Abel de Almeida Neto Luiz Otávio Ribeiro de Lemos Felgueiras Karine Grillo de Freitas Thiago dos Santos Ferreira Richell Bastos Vale;Bruno Vítor Martins Santiago;José Abel de Almeida Neto;Luiz Otávio Ribeiro de Lemos Felgueiras;Karine Grillo de Freitas;Thiago dos Santos Ferreira

作者机构：Department of Anesthesiology Piedade Municipal Hospital Rio de Janeiro Brazil Department of Anesthesiology Marcílio Dias Naval Hospital Rio de Janeiro Brazil Interleague Association of Anesthesiology of the State of Rio de Janeiro Rio de Janeiro Brazil 

出 版 物：《Case Reports in Clinical Medicine》 (临床医学病理报告（英文）)

年 卷 期：2021年第10卷第9期

页      面：232-239页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Headache Opioids Herpes Simplex Dural Puncture 

摘      要：The study seeks to report the clinical evolution of a patient who suffered an inadvertent subarachnoid puncture and evolved with a herpetic viral meningitis, confirmed by cerebrospinal fluid (CSF) analysis. Female, 48 years old, submitted to epidural anesthesia, for surgery, with median puncture, between L2-L3 and inadvertently accessed the subarachnoid space, with clear cerebrospinal fluid. The same puncture was used and the solution with 15 mg hyperbaric bupivacaine and 80 mcg morphine was administered. There was no complication during the entire surgical procedure. On the first postoperative day, she started complaining of headache and nausea, being treated with dipyrone, non-steroidal anti-inflammatory drugs (NSAIDs) and ondansetron. On the third day, she presented two episodes of seizure that ceased with the use of diazepam 10 mg. On the fifth day, the patient presented fever and seizures, which did not stop with medication, requiring sedation, orotracheal intubation and transfer to the intensive care unit. Lumbar puncture was performed for CSF analysis, which was positive for Herpes simplex type I. The patient was extubated, on the second day of hospitalization, maintained with a maintenance dose of phenytoin, sumatriptan, dipyrone, metoclopramide and acyclovir 500 mg, remaining intravenous, without presenting new seizures for 45 days, when she was discharged. After 30 days, he returned for a review consultation without making a complaint.