成人重症型流行性乙型脑炎临床特点分析

目的分析9例成人重症型流行性乙型脑炎的临床特点。方法 2013-10我科共收治9例经血清和脑脊液检查证实的成人重症型流行性脑炎患者,回顾性分析其临床主要症状、血及脑脊液实验室检查、头颅MRI检查,以及临床治疗情况和最终结果。结果本组发病年龄19~60岁,中位数49岁;均来自同一省或发病前1周曾去过该省;除1例外,其他8例均无明确乙脑疫苗接种史;临床症状为高热(100%)、意识障碍(昏睡66.6%,嗜睡33.3%)、抽搐发作(66.6%)、呼吸衰竭(100%)及四肢瘫痪(100%);病死率达33.3%,其余均有四肢瘫痪等严重后遗体征;白细胞正常或轻度增高,以中性粒细胞及淋巴细胞为主;脑脊液压力为165~290mmH2O,以淋巴细胞为主,糖、氯及蛋白正常或轻度增高;脑电图均为低波幅慢波,未见癫痫波;头颅MRI示双侧颞叶内侧、大脑脚、丘脑长T1、长T2异常信号,FLAIR呈高信号,无强化;血清及CSF乙脑特异性IgM抗体阳性。年龄、意识障碍、呼吸衰竭和四肢瘫可能与患者死亡相关。结论成人也是流行性乙型脑炎的易感人群,重症成人患者以高热、意识障碍、四肢瘫及呼吸衰竭尤为突出,病死率高,存活者遗留严重的功能障碍。乙脑是疫苗可预防性疾病,有必要对成人进行乙脑疫苗补种。     

流行性乙型脑炎的影像学改变2例报告

关于流行性乙型脑炎 (乙脑 )影像学改变的报道不多 ,现报告 2例如下。1　病例1.1　例 1　女 ,2 0岁。因发热、头痛 8天 ,意识不清 4天于2 0 0 0年 8月 16日入院。患者入院前 8天无明显诱因发热 (Ｔ39～ 4 0℃ ) ,伴剧烈头痛、恶心、呕吐。 4天后出现不语、吞咽困难、饮水呛咳、小便失禁、阵发性意识丧失、双上肢抽动 ,继而躁动、呼吸急促。查体 :体温 38.9℃ ,呼吸 2 8次 /分 ,脉搏10 0次 /分 ,血压 16 / 8.5ｋＰａ ,昏睡 ,呼吸表浅 ,咳嗽无力 ,双肺呼吸音粗 ,心律齐 ,无杂音。双侧瞳孔 3ｍｍ ,对光反应存在 ,眼球运动查体不配合 ,眼底 (- )…     

流行性乙型脑炎的影像学特点

目的：分析流行性乙型脑炎的MRI表现特征，探讨MRI对流行性乙型脑炎诊断价值。方法：回顾分析经临床和血清学证实的4例流行性乙型脑炎不同发病时期的MRI资料，其中成人1例，儿童3例。MRI均采用常规横轴位T1WI和T2WI，冠状面FLAIR及DWI。成年患者还经钆喷酸葡胺（GD2DTPA）增强检查。结果：4例患者MRI都有双侧丘脑、中脑病变，其中2例还有大脑皮质病变。增强扫描病灶未见强化。结论：流行性乙型脑炎的MRI特征是双侧丘脑和中脑异常信号。     

婴儿流行性乙型脑炎实验室检查结果及临床特点

为探讨婴儿期乙脑实验室检查结果的变化规律，本文进行了初步研究，现报告如下。     

85例流行性乙型脑炎的临床分析

流行性乙型脑炎(简称乙脑)是由流行性乙型脑炎病毒引起的中枢系统的传染病。本病流行于夏秋季,主要集中在7、8、9月份。临床表现以急性发热、头痛起病,迅速出现意识障碍、惊厥、脑膜刺激征等中枢神经系统症状,重者病死率高,幸存者也往往留有后遗症。发病年龄多在2~10岁。现将我     

47例流行性乙型脑炎的临床分析

流行性乙型脑炎(简称乙脑)是由流行性乙型脑炎病毒引起的,以脑实质炎症为主要病变的中枢系统急性传染病,常流行于夏秋季,临床以发热、头痛起病,迅速出现意识障碍、抽搐、病理反射、脑膜刺激征等中枢神经系统症状,病死率高,部分病人留有后遗症,发病年龄多在2～10岁.现将我院2003-2008年收治的47例患者报告如下.     

粟粒性结核性脑膜脑炎的临床及影像学特点(附2例报告)

目的 探讨粟粒性结核性脑膜脑炎的临床及影像学特点.方法 回顾性分析2例粟粒性结核性脑膜脑炎患者的临床资料.结果 本组患者男、女各1例,发病年龄分别为45、76岁,结核病病程1～5年.临床表现以发热、头痛为主,均为急性起病且有活动性肺结核,其中1例合并有胸椎结核.头颅MRI检查示2例患者脑膜及脑实质内均可见大小相似的粟粒性结核病灶,增强扫描可见病灶强化.经抗结核治疗1个月后,复查头颅MRI示病灶消失.结论 粟粒性结核性脑膜脑炎患者常伴活动性结核病,头颅MRI检查示颅内大量粟粒性结核病灶且增强扫描后明显强化为其特征性影像学表现,抗结核治疗的效果较好.     

成人流行性乙型脑炎临床特征的回顾性分析

目的分析成人流行性乙型脑炎(JE)的临床特征。方法收集2017年7月到2019年12月在中国人民解放军联勤保障部队第九四〇医院确诊并住院的37例JE患者的临床资料,以JE临床分型及是否出现呼吸衰竭,分为JE1组(n=21)和JE2组(n=16),分析JE的临床特征。结果 37例患者平均发病年龄为(50.9±17.2)岁,最常见的临床表现为发热(100%)、脑膜刺激征阳性(83.8%)、意识障碍(78.4%)、头痛(70.3%)及精神症状(62.2%)。与JE1组相比,JE2组肢体瘫痪、腱反射减弱、肌张力减低、肺部感染的发生率显著增高,住院时间显著延长(均P0.05),此外血白细胞计数、血中性粒细胞百分比、C反应蛋白水平、血尿素水平、血二氧化碳分压、颅内压、CSF葡萄糖水平显著升高(均P0.05),而GCS评分、血淋巴细胞百分比、血氯化物、血氧分压、氧合指数、CSF氯化物水平显著下降(均P0.05)。头颅MRI示JE患者病变主要累及丘脑和基底节区,EEG多为慢波,JE2组EEG异常比例显著多于JE1组(P0.05)。37例患者中死亡5例(13.5%),均来自JE2组;幸存者中25例(78.1%)存在认知功能障碍。结论发病后合并呼吸衰竭的JE患者临床症候更重,合并感染更多,住院时间更长,预后更差。     

脑干脑炎的临床与影像学特点

目的 探讨脑干脑炎(BSE)的临床与影像学特征.方法 对11例BSE患者的临床资料进行回顾性分析.结果 本组患者中7例发病前有上呼吸道感染史;急性起病9例.哑急性起病2例;临床表现眩晕8例,口齿不清、吞咽困难及呛咳7例,走路不稳6例,头痛及恶心呕吐各5例,复视及呃逆各3例,尿潴留2例;多个脑神经损害10例,锥体束征10例,小脑征8例,感觉长束征7例,Horner征3例,深昏迷1例.8例CSF检查中细胞数增高6例,蛋白含量增高4例;7例脑干听觉诱发电位检查中6例异常;MRI检查均显示脑干内有异常病灶,其中延髓9例、脑桥5例、中脑2例,累及脑干外的病灶中小脑及颈髓各2例,右脑桥小脑脚1例.经皮质类固醇激素等治疗后6例基本痊愈、3例明显好转,随访2～9年,9例无复发.结论 BSE患者多有前驱感染史;临床上以多个脑神经损害、长束征及小脑征为主;病灶位于延髓、脑桥多见,可累及脑于外邻近组织;颅脑MRI对诊断BSE具有重要意义;BSE多呈单相病程,多数患者预后良好.     

病毒性脑炎急性期继发癫痫的临床特点

目的:分析病毒性脑炎急性期继发癫痫的临床特点。方法:1982年4月5日～2003年12月15日连续住院的374例病毒性脑炎患者,采用统一的调查表,用Microsoft Access 2002建立数据库,共51个主项内容,部分主项有下属分项。分析患者癫痫发病情况,对比观察继发癫痫患者和无癫痫发作患者脑电图结果及预后情况。结果:374例中115例(30.8％)继发癫痫,其中全面发作72例(62.6％),单纯部分发作18例,复杂部分发作11例,部分继发全面14例。115例患者中23例(20.0％)出现癫痫持续状态,14例(12.2％)继发多系统损害,普通脑电图检查20例发现痫性放电,占17.4％。继发癫痫组额叶、颞叶损害共54例,占47.0％。继发癫痫组与无癫痫发作组比较,脑电图异常程度差异有显著意义(x2=23.6,P<0.01),大脑皮质损害发生率差异有显著意义(x2=85.53,P<0.001)。继发癫痫组住院天数26.1±23.6,无癫痫发作组住院天数17.9±5.0,二者比较差异有显著意义(t=5.33,P<0.001)。结论:急性病毒性脑炎后继发癫痫发作以全面发作最为常见,大脑皮质损害易于继发癫痫,癫痫发作影响病毒性脑炎患者病情恢复。     

成年和儿童日本脑炎患者的临床分析

目的研究成年和儿童日本脑炎患者的临床差异。方法回顾性分析2004-07~2006-09我院治疗的日本脑炎患者,分为成年组和儿童组(<14岁,不包括新生儿),评定其临床资料和3个月时的预后。结果72.9%的患者来自经济卫生条件差的农村,14名成年(60.9%)和22名儿童(88%)患者出现癫发作(χ2=4.70,P<0.05)。2组患者在神经功能缺失、影像学及脑脊液分析方面无明显差异。成年患者急性期病死率高,而3个月时成年生存患者的预后好(χ2=7.96,P<0.05)。结论成年患者急性期病死率高,3个月时的预后较好;癫发作少见于成年患者,2组脑电图也有不同表现。上述差异可能与免疫因素、神经元可塑性及分化相关。     

流行性乙型脑炎112例临床分析

目的分析流行性乙型脑炎(乙脑)的临床表现与临床流行病学规律,明确该病有效预防措施。方法2003年5月至2007年12月治的112例乙脑的临床资料,观察其临床流行病学特点及临床特征。结果本组112例患者均为儿童,男63例,女49例,年龄4岁～12岁,平均年龄为4.65±0.75岁,其中89(79.46%)例为爆发流行病例,23(20.53%)例为散发流行病例,103(91.96%)例没有乙脑疫苗接种史。以急性起病,高热,头痛、多数患者有意识障碍(96例,85.71%)及癫痫发作(61例,54.46%),发病第二周血清或脑脊液乙脑IgM阳性。本组患者81(72.32%)例临床治愈,18(16.07%)例住院期间死亡。结论本病的临床特征主要为儿童罹患,发热、头痛为常见的临床表现,发病第二周血清或脑脊液乙脑IgM阳性,重症患者死亡率高,而夏秋季发病为其主要临床流行病学特点。乙脑疫苗注射仍是目前主要行之有效的预防措施。     

日本脑炎28例患者的预后分析

目的评估日本脑炎(JE)患者预后的影响因素。方法回顾性分析2004年7月～2008年9月我院治疗的28例JE患者,评定其临床资料及6个月时预后。结果 28例JE患者6个月时随访,9名患者死亡,8名患者预后差,生活不能自理。结论呼吸衰竭、癫、深昏迷(GCS<6)、颅内压显著增高(>240mmH2O)和脑电图异常及影像学病变范围广与结局差相关(P<0.05),而呼吸衰竭、频发癫(>2次)、颅内压显著增高和深昏迷与死亡密切相关(P<0.05)。积极控制成年JE患者出现的癫发作和高颅压可能是改善预后的关键措施。     

Japanese encephalitis in Western Europe

Japanese encephalitis is the leading cause of viral encephalitis in Asia. In Western Europe, however, Japanese encephalitis has not been reported so far.     

Movement disorders in Japanese encephalitis

Movement disorders in Japanese encephalitis (JE), although reported, have not been analyzed systematically. In this study, we report an analysis of movement disorders in 14 out of 17 JE patients, correlated with the radiological findings. All patients had at least a four fold rise of IgG antibodies against JE in a haemagglutination inhibition test. The patients’ ages ranged between 2 and 54 years and 4 of them were women. Extrapyramidal signs, such as hypokinesia, hypophonia and masking of the face, were present in all patients by the first month as the patients came out of the coma – except for 1 patient. Eight patients had axial and 3 tongue dyskinesia; rigidity was present in 6 and tremor in 2 patients. At 3 months, these symptoms improved considerably in 6 patients. Cranial CT scan revealed thalamic involvement in 10, which was bilateral in 9 patients. Two patients had brain stem and one had cerebellar involvement. Cranial MRI was carried out in 9 patients and revealed additional findings in lentiform nucleus, midbrain and pons in 3 each and cerebellum in 4 patients. Bilateral thalamic involvement on MRI was seen in all the patients, including two patients whose CT scans were normal. SPECT studies using ^99mTc-ECD revealed bilateral thalamic hypoperfusion in all (n = 7) and frontal hypoperfusion in 3 patients. In JE, movement disorders are common and may be due to thalamic involvement in isolation or in combination with basal ganglia or midbrain or both. Received: 19 August 1996 Received in revised form: 6 January 1997 Accepted: 13 January 1997     

Japanese encephalitis-induced anti-N-methyl-d-aspartate receptor encephalitis: A hospital-based prospective study

ObjectivesA hospital-based prospective study was performed to determine: 1) whether Japanese encephalitis (JE) normally triggers anti-N-methyl-d-aspartate receptor (NMDAR) immunoglobulin G (IgG) synthesis, especially in monophasic JE patients; and 2) the incidence of JE-induced anti-NMDAR encephalitis in pediatric patients with JE.MethodsWe detected the level of anti-NMDAR IgG in the serum and cerebral spinal fluid (CSF) of JE patients within one week of onset. If patients relapsed during the convalescence phase, we detected JE virus RNA in the CSF and anti-NMDAR IgG in both the serum and CSF. For patients who did not relapse during the convalescence phase, serum was collected and anti-NMDAR IgG was detected during the 30–60-day course of the disease.ResultsWe enrolled 65 JE patients, who were negative for anti-NMDAR IgG in the serum and CSF during the acute phase, of which 63 patients were successfully followed up. Five patients relapsed during the convalescence phase, for whom JE virus RNA in the CSF was negative and excluded latent JE reactivation. The distinctive symptoms of four younger patients were choreoathetosis, whereas the psychiatric and behavioral manifestations were the distinctive symptoms experienced by the teenager. Anti-NMDAR IgG in the CSF of three patients was positive and they were diagnosed with anti-NMDAR encephalitis. The other two patients were negative for anti-NMDAR IgG in both the serum and CSF. For the 58 patients who did not relapse during the convalescence phase, anti-NMDAR IgG was negative in the serum of all patients at 30–60 days during the course of the disease.ConclusionsJE does not typically trigger anti-NMDAR IgG synthesis. Besides anti-NMDAR IgG, other unknown autoantibodies can also cause autoimmune encephalitis in the convalescence phase of JE. The incidence of JE-induced autoimmune encephalitis in pediatric patients with JE was 7.9%, and the incidence of JE-induced anti-NMDAR encephalitis was 4.7%.