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[Aseptic meningitis as a complication caused by an allergic reaction after microvascular decompression: two case
Hirooki Wakamoto1, Hiromichi Miyazaki, Maaya Orii
1Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-city, Kanagawa 254 0065, Japan.
Abstract:
We report here two cases of patients complicated with aseptic meningitis after microvascular decompression (MVD). The first case, a 56-year-old female complained of headache with high fever 18 days after the MVD for right trigeminal neuralgia. The amount of cells in cerebrospinal fluid (CSF) had so much increased that bacterial meningitis was suspected. However, there was no improvement after antibiotics therapy, so immune globulin was injected and the meningitis gradually improved. Eosinophilia remained in peripheral blood and the symptoms improved rapidly after the steroid therapy. Because of this, we suspected that meningitis was caused by an abnormal allergic reaction. The second case, a 30-year-old male complained of headache with mild fever 15 days after MVD for left hemifacial spasm. The amount of cells in CSF increased, so bacterial meningitis was suspected. Eosinophilia remained in peripheral blood and the steroid therapy proved very effective for the meningitis. Because of this, we suspected that meningitis was caused by an abnormal allergic reaction. We suspected that the two patients suffered from aseptic meningitis caused by allergic reaction, and the antigen for this abnormal allergic reaction was the foreign materials used for MVD. The materials were Dacron for prostesis, Goatex or Lyodula for dural plasty, fibrin glue for preventing CSF leakage. We ascertained that the abnormal allergic reaction was caused by human fibrinogen in the second case. It is important to be aware of such allergic reaction to fibrin glue in the post-operative stage after MVD.
Insights
Microvascular decompression (MVD) can lead to aseptic meningitis due to allergic reactions to surgical materials like fibrin glue. Steroid therapy is effective in treating this post-operative complication.
Area of Science:
- Neurology
- Immunology
- Neurosurgery
Background:
- Microvascular decompression (MVD) is a surgical procedure to treat neurological conditions like trigeminal neuralgia and hemifacial spasm.
- Post-operative complications following MVD can include meningitis, which is often initially suspected to be bacterial.
Observation:
- Two patients developed aseptic meningitis with elevated cerebrospinal fluid (CSF) cells and peripheral eosinophilia after MVD.
- Symptoms included headache and fever, initially mimicking bacterial meningitis and unresponsive to antibiotics.
Findings:
- Treatment with immune globulin and corticosteroids led to symptom improvement, suggesting an allergic etiology.
- The allergic reaction was suspected to be triggered by foreign materials used during MVD, specifically human fibrinogen in fibrin glue.
Implications:
- This highlights the importance of considering allergic reactions to surgical materials, particularly fibrin glue, in post-MVD aseptic meningitis.
- Awareness of this potential complication can guide appropriate diagnosis and treatment, improving patient outcomes after MVD procedures.