小儿病毒性脑干脑炎九例临床分析

病毒性脑干脑炎是指各种病毒感染所引起的脑实质及其脑干的炎症。小儿时期病毒性脑干脑炎并不多见，由于其可引起脑干重要生命中枢功能障碍，预后大多凶险。为提高对病毒性脑干脑炎的认识，现将我院收治的9例病毒性脑干脑炎患儿的临床资料作一回顾性分析。     

小儿病毒性脑炎150例临床分析

1985～1991年共收治病毒性脑炎150例中,男89例,女61例,以学龄儿童为多。首发症状依次为癫癎样抽搐、头痛及呕吐、意识障碍、瘫痪、精神异常、视力障碍、失语及尿潴留。临床表现有意识障碍85例。抽搐70例,精神失常41例,颅神经损害22     

小儿病毒性脑炎360例临床分析

我科自1999年12月～2002年2月共收治病毒性脑炎360例,其中男200例,女160例;年龄:3个月～3岁210例,～8岁100例,～13岁50例。主要集中在6、7、8月份,7月份为高峰期。全部病例均有不同程度的发热,其中37～38.5℃之间170例,头痛160例,呕吐200例,精神差280例,抽搐6例,昏迷3例,脑膜刺     

小儿散发病毒性脑炎82例临床分析

我科于1999年1月～2004年12月收治病毒性脑炎82例，经临床治疗后病情好转，疗效显著，现报告如下。     

小儿病毒性脑炎80例分析

本文报道了80例小儿病毒性脑炎(1月～15岁)。首发症状为发热、呕吐、抽搐、头痛、意识障碍、头晕、不自主运动、颅神经障碍、肢体瘫痪和一些精神症状。EEG检查62/63异常。23例进行连续观察,发现EEG多随病情好转而改善或恢复正常。门诊随访24例,脑干听觉诱发电位(BAEP)检查15例,其中9例异常,听力损害发生率60%,周围性听路损害2例,中枢性听路损害4例,混合性听路损害3例。从BAEP电生理检查角度进一步证实了病毒性脑炎是一种脱髓鞘病变,对了解预后观察中枢神经系统功能恢复情况有一定帮助。     

小儿脑干脑炎

小儿脑干脑炎较少见,现认为与Miller-Fisher综合征同属跟肌麻痹-共济失调-反射消失综合征。病理机制系脑干部位不同病原感染后的变态反应,临床以颅神经与锥体束、感觉传导束的交叉综合征为基本特点。本文结合部分文献对该病作一综述,以期对诊断及治疗有所认识。     

小儿单纯疱疹病毒性脑炎15例临床分析

临床资料 :1995年 1月至 2 0 0 1年6月 ,本院收治小儿单纯疱疹病毒性脑炎 15例 ,病程 1周至 2个月。 15例中男 9例、女 6例 ;年龄 <2 8d 1例 ,2 9d至 5岁 4例 ,>5岁 10例。临床表现为上呼吸道感染症状 (发热、头痛、呕吐、乏力 ) 10例 ,口唇单纯疱疹 5例 ,抽搐 9例 ,精神异常 6例 ,面神经麻痹 4例 ,昏迷 3例 ,偏瘫 2例 ,脑疝 1例。 15例中腰穿查脑脊液压力均增高 ,细胞数 (5 0～ 6 5 0 )× 10 6/L ,淋巴 0 6 0～ 0 95 ,红细胞增多 3例 ,糖 <2 75mmol/L6例、≥ 2 75mmol/L9例 ,氯化物均正常。脑脊液细菌培养均阴性。酶联免疫吸附(ELIS…     

41例小儿散发性病毒性脑炎脑干听觉诱发电位的观察

本文应用BAEP对41例小儿散发性病毒性脑炎进行测试,结果15例(35%)PL,LPL及波幅有不同程度异常,提示脑干听神经通路受累。发现BAEP异常与本症患儿意识障碍程度相关,9例昏迷病儿均有显著BAEP异常,但与颅内压增高无明显关系。29例有颅内压增高者只有7例有不同程度BAEP异常。作者指出,BAEP可作为小儿散发性病毒性脑炎颅内病损的客观指标,更因其敏感、稳定、无损伤和操作简便,值得推广应用。     

小儿病毒性脑炎

小儿病毒性脑炎正常分为急性和亚急性二大类。据Beghi 统计,乳幼儿发病为21.8人/10万,1～4岁为15.4/10万,5～9岁25.1人/10万,10岁以上3.1人/10万。本文就急性单纯疱疹脑炎和引起亚急性发病的麻疹、风疹脑炎加以综述。单纯疱疹病毒性脑炎单纯疱疹病毒性脑炎(HSVE)不仅病死率、病残率高,予后差,而且发病率日益增加,成为目前各国病毒性脑炎重要原因。自1977年Whitley 报告应用脑活检进行早期诊断,早期投用阿糖腺苷(Ara-A)等抗病毒药物,本病予后大有改观,病死率由70%下降到20～40%。(一)早期诊断主要是依据临床表现。脑脊液(CSF),脑电图,头部CT     

重症病毒性脑炎患儿非惊厥性癫痫持续状态9例临床分析

目的 通过分析重症病毒性脑炎患儿非惊厥性癫痫持续状态（NCSE）的临床特征、诊断和治疗,提高对NCSE的认识。方法 回顾性分析2012年6月至2014年9月广州市妇女儿童医疗中心神经内科诊断为重症病毒性脑炎NCSE的病例。结果 ①9例重症病毒性脑炎NCSE连续病例进入本文分析,男5例。脑炎起病年龄（7.2±3.9）岁;Glasgow评分（8.6±1.9）分;脑炎起始与NCSE起始间隔4~70（19.4±20.9）d;昏迷中癫痫持续状态（SEC）4例,复杂部分发作持续状态4例,不典型失神发作持续状态1例。②病因包括病毒性脑炎8例,病毒性脑炎抗癫痫药物调整1例;9例前驱均有惊厥,其中3例伴惊厥性癫痫持续状态。③9例临床发现主要有口面部或肢体微小抽动、认知障碍、孤独症样行为等。④VEEG发作期主要以背景活动变慢,伴δ、θ、β、棘节律,或棘慢波持续发放为特征。⑤4例SEC患儿予麻醉药联合多种抗癫痫药物治疗,发作平均持续42.8 d;5例非SEC患儿予多种抗癫痫药物治疗,其中3例发作平均持续9 d,1例抗癫痫药物调整所致NSEC发作持续4个月。⑥1例自动出院失访,1例死亡,余7例随访3个月至2.5年;6例VEEG均有不同程度的发作期或发作间期脑电异常,1例正常;1例神经学功能正常,5例有不同程度认知下降伴继发性癫痫,1例持续植物状态伴继发性癫痫。结论 口面部或肢体运动现象、认知及行为改变为重症病毒性脑炎患儿NCSE临床特征;发作期脑电波形变异大,棘节律可能是重症病毒性脑炎患儿NCSE的独特形式;抗癫痫治疗及起效时间与NCSE类型相关。     

Acute viral encephalitis in children

Fifty-seven cases satisfying criteria of the diagnosis of acute viral encephalitis were studied. They were divided into two groups: Group 1 (presumed), 48 cases; Group 2 (postinfectious), nine cases. A possible association of viral aetiology was found in 26%. Viruses isolated were: influenza (3 cases), Coxsackie virus (2), adenovirus (2), mixed cytomegalovirus and adenovirus and herpes simplex viruses (1 case each). The mortality rate was 28%. Among the 41 survivors, 76% were completely normal and 24% had neurological sequelae with focal neurological deficit in 29%; personality changes in 6%; moderate mental retardation in 2%; severe mental retardation in 4%; hyperactivity in 4% and epilepsy in 4%. The best predictors to unfavourable outcome were the rapid rate of deterioration in conscious level after admission and the age of the patients.     

Acute viral encephalitis in children

Fifty-seven cases satisfying criteria of the diagnosis of acute viral encephalitis were studied. They were divided into two groups: Group 1 (presumed), 48 eases; Group 2 (postinfectious), nine cases. A possible association of viral aetiology was found in 26%. Viruses isolated were: influenza (3 cases), Coxsackie virus (2), adenovirus (2), mixed cytomegalovirus and adenovirus and herpes simplex viruses (1 case each). The mortality rate was 28%. Among the 41 survivors, 76% were completely normal and 24% had neurological sequelae with focal neurological deficit in 29%; personality changes in 6%; moderate mental retardation in 2%; severe mental retardation in 4%; hyperactivity in 4% and epilepsy in 4%. The best predictors to unfavourable outcome were the rapid rate of deterioration in conscious level after admission and the age of the patients.     

病毒性脑炎患儿血清和脑脊液中Gal-9的变化

目的探讨病毒性脑炎(VE)患儿血清和脑脊液中半乳糖凝集素-9(Gal-9)的变化,及其对疾病的诊断、判断预后的指导意义。方法采用双抗体夹心酶联免疫吸附法检测VE患儿急性期、恢复期以及对照组血清和脑脊液中Gal-9的水平,并进行比较。结果 VE患儿急性期、恢复期以及对照组患儿进行比较,三组的血清和脑脊液中Gal-9水平的差异均有统计学意义(F=92.60、81.90,P0.01)。其中,VE患儿急性期、恢复期的血清和脑脊液中Gal-9水平均高于对照组,差异有统计学意义(P0.01);VE恢复期的血清和脑脊液中Gal-9水平均高于急性期,差异有统计学意义(P0.01)。VE和对照组全体患儿血清中Gal-9水平与脑脊液中Gal-9水平呈正相关(r=0.523,P0.01)。VE患儿脑脊液中Gal-9水平与有核细胞数呈负相关(rs=-0.469,P0.001)。结论 Gal-9可能参与VE的发病过程。     

Study of Japanese encephalitis and other viral encephalitis in Nepali children

BACKGROUND: A hospital-based prospective cross-sectional study was conducted in children aged 1 month-14 years to identify the proportion of viral encephalitis due to Japanese encephalitis (JE) and compare the clinico-laboratory profile and outcome of JE with that of other viral encephalitis (non-JE). METHODS: All probable cases of viral encephalitis on clinical and laboratory evaluation were confirmed as JE on anti-JE IgM in cerebrospinal fluid (CSF) and/or serum. Patients not having anti-JE IgM in CSF and/or serum were diagnosed as having non-JE. RESULTS: Of 94 cases, 58 were JE and 36 non-JE. Although practice of rearing pigs at home was associated with JE (P = 0.0001), significantly higher serum creatinine, protein, aspartate aminotransferase and CSF protein levels were observed in non-JE. Longer duration of fever was associated with complete recovery in JE whereas shorter duration of fever was associated with recovery in non-JE. Risk of neurological sequelae (P = 0.01), especially hemiparesis (P = 0.03) was significantly more in JE. Sequelae were observed at 6 weeks follow up in 18.8% of JE and 13.9% of non-JE. CONCLUSION: JE was the most common cause of viral encephalitis in eastern Nepal and should be suspected in encephalitic patients having pig rearing at home and neurological sequelae. Although duration of hospitalization and complication were higher in JE, final outcome was similar to non-JE. Longer duration of fever in JE and shorter duration of fever in non-JE correlated with recovery, while altered sensorium and focal neurological deficit were independent predictors of sequelae at 6 weeks only in JE and not in non-JE.     

Acute viral meningitis and encephalitis in children

Both viral meningitis and encephalitis in infants and children give clinical features of various severity. The mechanism of viral encephalitis varies from CNS cellular destruction, immune or oedematous process. The clinical and EEG features of herpes encephalitis in the child are usually well recognizable. CSF characteristics are important for differential diagnosis. Management therapy includes anti-oedema treatment, prevention or cure of seizures. Passive immunisation against rubella, rubeola and measles is the best prevention therapy for post-infectious encephalitis. Herpes encephalitis prognosis has improved with acyclovir therapy. In France, mortality due to post-infectious encephalitis is estimated below 5% and sequellae below 20%.     

Management and outcome of viral encephalitis in children

Although viral encephalitis (VE) is relatively uncommon in children in the UK, early recognition and appropriate investigation and management are essential because of the devastating nature of the condition. An estimated 1200 paediatric cases from all causes are admitted each year. The cause of VE is diagnosed in approximately 30% of cases. The commonest cause in the UK is herpes simplex virus type 1 but globally the most important cause is Japanese encephalitis virus. Diagnostic methods have improved recently and the yield can be increased with a rational approach to investigations and by taking specialist advice. Morbidity and mortality are high but can be significantly reduced in herpes simplex virus encephalitis by treating for at least 14 days with intravenous aciclovir. Sequelae are common and include motor, sensory and cognitive impairments, epilepsy, behaviour problems and psychiatric disorders. Children should have access to a neurorehabilitation team, which includes a neuropsychologist, to achieve the best recovery possible. Long term follow-up and an organized transition into adult services is required.     

磁共振成像在重症病毒性脑炎患儿中的应用

病毒性脑炎是儿童常见的中枢神经系统感染性疾病,重者可危及生命,存活者亦可遗留不同程度的神经系统后遗症[1,2]。因此早期诊断,确定病变部位并积极治疗是控制疾病进展、降低病死率及后遗症发生率的关键。本资料旨在回顾分析32例重症病毒性脑炎患儿的MR I表现,并结合临床探讨其