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.