Herpes simplex encephalitis. Clinical Assessment

Continuing evaluations of antiviral agents for treatment of herpes simplex encephalitis (HSE) provided an opportunity to collect clinical data from 113 patients in whom the diagnosis was proved by viral isolation. Occurrence of HSE was in all ages and in both sexes and was nonseasonal. Characteristically, patients had behavioral changes, fever, confusion, speech disturbances, and, less frequently, seizures. The EEG was the most useful neurodiagnostic aid followed by technetium and computed axial tomographic scans. Employing a logistic regression model for variable selection, the diagnosis could be predicted by clinical findings and neurodiagnostic tests in 83% of the proved cases, but the evidence in 25% was falsely positive. There was evidence of localization by either clinical or neurodiagnostic assessment in all patients with proved disease. Among patients wtih negative findings for HSE, similar focal findings predominated in all but a few. The CSF and brain scans were normal in many patients with proved HSE. This extensive clinical experience in patients wtih diagnosis proved by viral isolation shows that diagnosis cna be confirmed only by brain biopsy.     

小儿病毒性脑炎的脑电图分析

目的:评价脑电图在小儿病毒性脑炎中的诊断价值,比较脑电图较其他方法对诊断小儿急性病毒性脑炎早期的优越性。方法:采用seiiate Harmonie 44数字化脑电图仪对62例病毒性脑炎患儿进行EEG检查,并且和其脑脊液、CT等的检查结果进行对比。结果:本组62例脑炎患儿,EEG轻度异常26例,中度异常22例,重度异常9例,正常者5例,阳性率91.9%,以发病后4~7天阳性率最高;CT结果异常14例,正常者48例,阳性率22.6%;脑脊液检查异常36例,正常者26例,阳性率58.1%。结论:在临床上有病毒感染史、EEG结果异常时,结合临床症状、体征,应考虑病脑的诊断。尽管脑电图的异常并非是病脑的特异性诊断指标,但其变化早于脑脊液及头颅CT,故对病脑的临床早期诊断有可靠的价值。     

60例急性病毒性脑炎的临床分析

目的　评价急性病毒性脑炎的诊断与治疗。方法　收集 1993～ 2 0 0 1年 6月的住院病案 60份 ,就临床症状、神经体征、周围血白细胞计数和分类、脑脊液、脑电图、脑CT检查 ,以及单用激素组和激素 +抗病毒毒药组之间的疗效关系进行分析。结果　本组病毒性脑炎可分为六种临床类型 :精神异常 ;持续性剧烈头痛伴呕吐 ;强直 -阵挛性抽搐 ;持续性意识障碍 ;脑神经损害、失语、偏瘫 ;小脑性共济失调。前三型最为常见 ,并且三型之间的临床现象有相互穿插出现的现象。经统计学处理 ,单用激素组与激素 +抗病药物组之间的疗效无显著性差异。结论　急性病毒性脑炎为一种自限性疾病 ,但在没有病毒学检查的情况下 ,尚应和急性播散性脑脊髓炎或多发性硬化作鉴别     

脑脊液二代测序对病毒性脑炎的诊断价值：附三例报告

病毒性脑炎是一种累及脑膜和脑实质的中枢神经系统感染性疾病，其临床表现为发热、抽搐、头痛等。因病毒性脑炎早期缺乏特异性临床症状，且病死率和致残率均较高，所以早期诊断尤为重要。本文介绍了3例采用宏基因组测序（mNGS）技术早期诊断出儿童疱疹病毒性脑炎的病例资料，相较于病毒性脑炎的传统检测方法，脑脊液二代测序能及早地做出病原学诊断，在早期诊断和指导临床治疗方面有重要的参考价值。     

4: Acute community-acquired meningitis and encephalitis

Acute meningitis and encephalitis are medical emergencies that require prompt assessment (usually by cerebral imaging and lumbar puncture) and treatment; specialist consultation is recommended. In acute meningitis, early administration of antibiotics can be life-saving (usually high-dose penicillin and/or a third-generation cephalosporin); antibiotics may be needed before referral to hospital. Emergence of penicillin and cephalosporin resistance in Streptococcus pneumoniae has necessitated more complex antibiotic regimens that include vancomycin or rifampicin for empirical treatment of meningitis. Adjunctive dexamethasone therapy may be of benefit in children with Haemophilus influenzae meningitis; there is no controlled evidence of its benefit in adults, but it could be considered in those with raised intracranial pressure. In possible encephalitis, empirical therapy with intravenous aciclovir should be given to cover herpes simplex virus (HSV) until the cause is established; HSV encephalitis may be fatal and leaves up to 50% of survivors with long-term sequelae.     

MRI changes associated with partial status epilepticus

Neurological disorders of different etiology may cause identical clinical symptoms requiring additional diagnostic procedures for a precise differential diagnosis. Focal epileptic seizures have been shown to cause increased signal intensities in T2 and diffusion-weighted magnetic resonance images (MRI), mimicking other neurological disorders or diseases such as viral encephalitis. In some cases even the combination of neuroimaging and cerebrospinal fluid (CSF) analysis is not sufficient to obtain the final diagnosis, since epileptic seizures may cause pleocytosis as well. Some epilepsy centers presented cases of focal status epilepticus with severe but reversible MRI changes. These cases indicate that MRI-changes following focal seizures are reversible over a different time window compared to MRI changes associated with other etiologies, such as viral infection. This data further suggest that in cases where focal seizures can not be ruled out, a follow-up MRI scan within a few days following the onset of symptoms significantly improves the precision of the differential diagnosis. Recently new scientific data were reported in this review.     

病毒性脑炎急性期治疗的进展

病毒性脑炎是指病毒感染引起的脑实质的炎症。发热、头痛、意识障碍、精神症状、抽搐、神经系统定位体征是其主要临床表现。许多病毒可引起该病,常见的有单纯疱疹病毒、水痘-带状疱疹病毒、巨细胞病毒、肠道病毒70及71、麻疹病毒、风疹病毒、流行性腮腺炎病毒及黄病毒属等,单纯疱疹病毒性脑炎是最常见的。目前临床大多采取综合性的治疗,抗病毒、脑细胞的保护、重要脏器功能的维持及并发症的预防。文章对该病急性期治疗的进展予以综述。     

病毒性脑炎患儿体内蛋白C水平的测定与临床研究

目的:探讨病毒性脑炎患儿体内蛋白C水平的变化及其临床意义.方法:选择2013年10月至2015年12月我院收治的102例病毒性脑炎患儿为观察组,另外同期随机选择我院100例因头痛症状就诊最终诊断为上呼吸道感染儿童为对照组.于入院24h内(急性期)和临床治疗1周后(恢复期)采集患儿静脉血与脑脊液标本用于检测蛋白C水平;采集并检测对照组健康儿童静脉血与脑脊液样本中蛋白C水平.结果:观察组患儿急性期血清与脑脊液中蛋白C水平均较恢复期及对照组健康儿童低,差异有统计学意义(P<0.05);观察组中急性期轻症患儿血清和脑脊液中蛋白C水平高于重症患儿,差异有统计学意义(t=2.542、2.115,P<0.05).结论:蛋白C水平可用于病毒性脑炎的早期诊断和感染严重程度的判断,对诊断病情和指导治疗有重要的临床价值.     

病毒性脑炎伴精神行为异常41例临床分析

目的:探讨精神行为异常为首发症状的病毒性脑炎的临床特点,以期早期诊断和治疗.方法:对精神行为异常为首发症状的41例病毒性脑炎的临床表现,脑脊液、脑电图和神经影像学资料进行回顾性分析.结果:呈急性或亚急性发病,主要早期表现为精神行为异常,伴有智能减退、发热、头痛、癫痫发作和意识障碍.常规脑脊液检查异常率43.9%,早期脑电图检查异常率92.7%,脑MRI检查异常率51.2%.结论:精神行为异常可以是病毒性脑炎的首发症状,常伴有智能减退、癫痫发作和意识障碍,结合脑电图、脑脊液、MRI和CT检查可以作出早期诊断和治疗.     

CT和MRI对急性Ⅰ型单纯疱疹病毒性脑炎的早期诊断的价值

目的探讨CT和MRI对急性I型单纯疱疹病毒性脑炎（HSE）的早期诊断价值。方法收集11例临床确诊为急性Ⅰ型HSE的早期病例的临床资料,对CT和MRI表现进行分析和比较。结果 HSE早期病例影像学表现按侵犯部位分为两种类型,侵犯基底节、丘脑、脑干的患者主要表现为＂基底节突显＂征;侵犯大脑额颞叶皮髓质区的患者主要表现为＂刀切征＂。结论 CT和MRI有助于对HSE的早期诊断。     

CT和MRI对急性Ⅰ型单纯疱疹病毒性脑炎的早期诊断的价值

目的 探讨CT和MRI对急性I型单纯疱疹病毒性脑炎(HSE)的早期诊断价值.方法 收集11例临床确诊为急性Ⅰ型HSE的早期病例的临床资料,对CT和MRI表现进行分析和比较.结果 HSE早期病例影像学表现按侵犯部位分为两种类型,侵犯基底节、丘脑、脑干的患者主要表现为"基底节突显"征;侵犯大脑额颞叶皮髓质区的患者主要表现为"刀切征".结论 CT和MRI有助于对HSE的早期诊断.     

病毒性脑炎106例脑电图和磁共振分析

目的评价MRI、EEG和CT对病毒性脑炎的诊断价值。方法回顾分析106例急性病毒性脑炎患者入院24h内CSF、EEG检查结果,48h内头颅CT和MRI检查结果。结果病毒性脑炎患者EEG阳性率达91.5%,MRI阳性率为61.1%,而CT阳性率仅34.4%。结论EEG联合MRI对病毒性脑炎诊断和鉴别诊断提供重要依据。     

免疫组化法对单纯疱疹病毒脑炎早期诊断的意义

目的：探讨免疫组化法对单纯疱疹病毒脑炎（ＨＳＥ）早期诊断的意义。方法：用免疫组化法检测９例ＨＳＥ脑组织石蜡保存标本的单纯疱疹病毒抗原（ＨＳＶ－Ａｇ）。结果：４例存在ＨＳＶ－Ａｇ，ＨＳＶ－Ａｇ分布于大脑皮质的神经元、胶质细胞、单核细胞。结论：免疫组化法检测脑组织中ＨＳＶ－Ａｇ是ＨＳＥ早期诊断的敏感方法之一。     

增强磁共振血管成像在病毒性脑炎与急性脑梗塞鉴别诊断的价值

目的：探讨磁显葡胺（Gd-DTPA）增强磁共振血管成像（简称Gd-DTPA MRA）表现及相关MRI改变对病毒性脑炎与急性脑梗死的诊断与鉴别诊断价值。方法：回顾性分析31例经临床诊断的病毒性脑炎和30例急性脑梗死的MRI及Gd-DTPA MRA表现,按疾病分组,分析病灶分布区域的血管状态。结果：Gd-DTPA MRA显示全脑动脉及细小分支和静脉系统;急性脑梗死Gd-DTPA MRA表现相应供血动脉有不同程度狭窄、闭塞、硬化;29例病毒性脑炎Gd-DTPA MRA表现正常。两种疾病在Gd-DTPA MRA存在差异（P〈0．05）。结论：Gd—DTPA MRA技术可快速而准确地显示颅内动脉狭窄或闭塞及其相应的脑梗死,结合常规MRI能及早对病毒性脑炎与急性脑梗死作出诊断和鉴别诊断。     

小儿单纯疱疹病毒脑炎22例临床分析

目的: 探讨小儿单纯疱疹病毒脑炎(herpes simplex encephalitis,HSE)的临床特点、检测手段及治疗。方法: 对22例经酶免疫斑点技术确诊为HSE的小儿的临床资料进行分析,所有病例均给予更昔洛韦(ganciclovir,GCV)治疗。结果: 小儿HSE多见于5岁以上农村患儿,临床表现以发热、呕吐、抽搐、瘫痪、意识障碍和锥体束征为主,头颅影像学检查多见额叶和颞叶损害,治愈7例,好转14例,未愈1例。结论: 小儿HSE临床表现不典型,血清中出现特异性单纯疱疹病毒IgM抗体是HSE的实验室诊断依据,头颅影像学表现为额颞叶损害时高度提示HSE,GCV是治疗小儿HSE的首选药物。     

Therapy of focal viral encephalitis in children with aciclovir and recombinant beta-interferon - results of a placebo-controlled multicenter study

Focal viral encephalitis in childhood is a rare but life-threatening disease. Animal experiments and case reports suggest a positive effect of an additional therapy with interferon-beta on the course of the disease. Therefore, we initiated a prospective, double-blind placebo-controlled study to investigate the benefit of a combination therapy of Aciclovir (ACV) and recombinant interferon-beta (rIFN-beta) in juvenile focal viral encephalitis. - Initial inclusion criterium was suspicion of focal viral encephalitis. Diagnosis was proven by demonstration of characteristic focal lesions in cerebral imaging or virological evidence of HSV in cerebrospinal fluid. Patients were treated with ACV plus rIFN-beta or ACV plus placebo. Neurological outcome was determined 21 days and 3 months after onset of the disease. - Initially 59 patients were enrolled in the study. Encephalitis was proven in 14 patients (7 ACV + rIFN-beta, 7 ACV + placebo). The study groups were balanced in terms of important prognostic criteria. 10 patients (5 ACV + rIFN-beta, 5 ACV + placebo) were cured or had slight defects, 4 patients (2 ACV + rIFN-beta, 2 ACV + placebo) showed moderate to severe defects. There was no significant difference in favour of the additive therapy with rIFN-beta.     

急性病毒性脑炎患儿血清中VEGF和IL-6水平的研究

目的:探讨血管内皮生长因子(VEGF)在急性病毒性脑炎(VE)发病机制中的作用及与白细胞介素(IL-6)的关系.方法:应用ELISA法检测42例VE患儿血清VEGF和IL-6水平,30例同年龄组非感染性神经系统疾病患儿做对照.结果:IL-6水平在VE的急性期与恢复期均比对照组明显升高,而且急性期IL-6水平也明显高于恢复期.有频繁抽搐、昏迷及脑干症状的重度患儿血清IL-6水平明显高于轻度患儿;VE的急性期和恢复期VEGF水平均较对照组升高,但3组比较无统计学意义.结论:IL-6可能参与VE的发病,高水平的血清IL-6对VE的诊断、临床严重性的评估有参考价值;VEGF水平增加,在病脑发病中的作用需进一步探讨.     

急性病毒性脑炎所致精神障碍51例临床分析

目的：探讨急性病毒性脑炎所致精神障碍的诊断、治疗。方法：在入院3天内对临床拟诊急性病毒性脑炎所致精神障碍的病人进行脑电图、头颅CT、脑脊液、脑彩超等检查。对临床拟诊急性病毒性脑炎所致精神障碍的病人采取抗病毒、免疫疗法、支持、对症治疗。结果：脑电图检查阳性率为96．1％，脑脊液检查阳性率为60．8％，CT检查阳性率为35．3％；脑彩超检查阳性率为33．4％。脑电图检查较脑脊液检查、CT检查、脑彩超检查阳性率高，差异有显著性（P〈0．05）。本组治愈率为84．3％。结论：脑电图检查阳性率高、且经济方便，可作为急性病毒性脑炎首选检查方法。对早期临床拟诊急性病毒性脑炎所致精神障碍的病人采取抗病毒、免疫疗法、支持、对症治疗，治愈率高。