儿童与成人病毒性脑炎MRI表现的对比分析

目的探讨儿童与成人病毒性脑炎MRI表现的差异。方法回顾分析57例临床确诊为病毒性脑炎的MRI结果,比较儿童与成人的MRI表现。结果儿童病毒性脑炎常表现为对称性病灶,且更易累及丘脑、脑干,较少累及大脑半球。而成人病毒性脑炎更易累及大脑半球。结论儿童与成人病毒性脑炎的发病部位存在差异,MRI能提供重要的诊断信息。     

表现为Gerstmann's综合征的病毒性脑炎1例

1 资料 患者,男,62岁,右利手,因"发热5 d,伴言语含糊、记忆力下降1 d"于2008年5月16日入院.5 d前受凉后反复于午后出现发热,体温最高达39.2℃,伴畏冷、鼻塞,腰骶部持续性疼痛,就诊当地诊所,先后予"头孢克洛、左氧氟沙星"抗感染治疗,"安痛定"肌注可暂时改善发热、腰骶部疼痛症状.     

小儿病毒性脑炎的诊疗体会

材料与方法病例选择: 系我院收治的临床确诊为病毒性脑炎的患儿, 诊断标准参照第五版儿科学. 将脑脊液PCR检测阳性的100例患儿随机分为治疗组与对照组. 治疗组50列, 其中男22例, 女28例, 平均年龄7.2岁; 对照组50例, 其中男29例, 女21例, 平均年龄6.8岁. 方法: 所有患儿留取急性期脑脊液送本校基因检测中心, 用PCR法一并检测HSV病毒, CV病毒和EV病毒. 对照组按常规治疗给药, 治疗组则在常规治疗基础上加用福康泰100万国际单位肌肉注射, 每日一次, 观察患儿体温、意识、脑电图恢复时间及平均住院日. 统计学处理: 实验数据以x 表示, 实验结果采用t检验.     

病毒性脑炎的脑电图分析及其临床意义

目的：探讨脑电图（EEG）对病毒性脑炎提供的诊断依据、对疾病严重程度的评价及评判药物疗效和预后的意义。方法：对84例病毒性脑炎的EEG进行回顾性分析,并对照CT及脑脊液检查。结果：84例中68例EEG异常,早期敏感性为81％。结论：病毒性脑炎的EEG早期敏感性高,对诊断有指导作用,可作为判断本病严重程度及治疗效果的依据之一。     

病毒性脑炎的诊断与治疗

病毒性脑炎是常见的中枢神经系统感染性疾病,由不同的病毒引起,在免疫能力正常的人群中单纯疱疹病毒（HSV-1）,水痘带状疱疹病毒（VZV）,EB病毒（EBV）,流行性腮腺炎病毒,麻疹病毒,肠道病毒感染引起的最为常见。病毒的种类、宿主的免疫状态和环境因素决定了受累的脑区以及疾病的预后。尽管目前特异的治疗仅限于几种病毒,但正确的诊断、对症支持治疗对预后极为重要。     

病毒性脑炎诊断技术的进展

病毒性脑炎(viral encephalitis,VE)是常见的中枢神经系统感染性疾病,是病毒入侵神经系统及相关组织引起的炎性或非炎性的改变.临床表现为精神行为异常、抽搐、发热及神经系统定位体征等.各型VE的诊断技术有许多共同点,但目前普遍缺少病原学与基因组学的诊断方法.快速准确的诊断方法是临床上治疗VE的指南针,近年来有关该病的诊断方法的研究有很大进展.     

病毒性脑炎与癫痫

病毒性脑炎常伴发癫痫。我们对近年来收治的病毒性脑炎作一回顾性研究,癫痫伴发率为62.69％,大多是大发作,且提示脑炎症状达高峰前出现癫痫发作的病例预后较好,反之则差;单纯疱疹病毒性脑炎较其他病毒性脑炎影像学检查异常率高,伴发癫痫率并不高。     

影响病毒性脑炎预后的因素

病毒性脑炎是指病毒感染所引起的脑实质的炎症。通常指急性非流行性病毒性脑炎(病脑)，主要包括疱疹病毒性脑炎和肠道病毒性脑炎，如单纯疱疹病毒性脑炎(HSE)、巨细胞病毒性脑炎、EB病毒性脑炎、水痘．带状疱疹病毒性脑炎等。每年美国单是HSE就有2万人发病。虽然不如脑卒中和脑外伤常见，但仍然是致死、致残的重要原因之一。病脑患者的     

Japanese encephalitis in the Kurume region of Japan: CT and MRI findings

Summary Neurological, computed tomography (CT) and magnetic resonance imaging (MRI) findings were recorded from 13 patients with Japanese encephalitis (JE) in the Kurume region diagnosed by serological criteria. The patients averaged 63 years of age, and 5 were older than 70 years. The serological data mostly indicated a primary response. Hemiplegia and tetraplegia were common, together with extrapyramidal signs. A few cases had a stroke-like onset and cerebral haemorrhage during the course of JE. CT and MRI in 7 cases revealed abnormalities in the thalamus and basal ganglia including the putamen. The CT and MRI findings from the acute stage to the convalescent stage were considered to be characteristic of JE.     

Cognitive and psychiatric impairment in herpes simplex virus encephalitis suggest involvement of the amygdalo-frontal pathways

The long-term neuropsychological and psychiatric sequelae of herpes simplex virus encephalitis (HSVE) and their relationship to the volume of temporal lesions and to amygdala and hippocampus damage remain undefined. We have conducted a prospective study of longterm sequelae in 11 patients with clinically presumed HSVE and detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction. Six months after encephalitis, patients underwent neuropsychological and language assessment. At the same stage, single photon emission computed tomography (SPECT) evaluated the occurrence of hypoperfusion with an index of asymmetry. MRI was used for the measurement of amygdala, hippocampus and cerebral lesions by two blind neurologists. The volume of the amygdala and hippocampus was compared with those of five controls, matched for age and level of education. Longterm memory disorders were seen in 6 patients, associated with the larger lesions and damage of at least two structures. Long-term behavioural changes with emotionalism, irritability, anxiety or depression were prominent in 7. Left prefrontal hypoperfusion appeared in 8 patients, associated with psychiatric disorders in 7 and left amygdala damage in 6. The reduction of amygdala and hippocampus volume was correlated with the overall volume of lesions. Different patterns of mesial temporal lobe damage occurred, involving either amygdala alone, or amygdala and hippocampus, but never hippocampus alone. MRI volumetric measurements in HSVE could be a good indicator of long-term prognosis. Persistant behavioural changes could be related to an amygdala and frontal dysfunction.     

Cerebellar encephalitis in adults

We examined 11 adult patients with cerebellar encephalitis (CE) during the acute phase of the disease and at least 12 months later. Five patients were aged between 23 and 31 years, 3 patients between 43 and 44 years and 3 patients between 60 and 64 years. Serological tests gave evidence of Epstein-Barr virus infection in 4 of the 5 young patients. Two patients had serological evidence of varicella-zoster virus reactivation, whereas the serological findings were negative in all other cases. All patients in the younger and middle age groups recovered within 3–30 weeks after onset of CE. If at all, they had only minor cerebellar deficits at the follow-up examination. Magnetic resonance imaging (MRI) examination performed at the follow-up examination was normal in all of them. In contrast, 2 of 3 patients older than 60 years had persistent cerebellar ataxia following CE. In these patients, MRI revealed infratentorial atrophy. Our data show that the clinical spectrum of CE in adults is wider than assumed so far. In addition to typical cases of CE in young male patients with good recovery, CE may also occur in older patients and give rise to persistent cerebellar ataxia.     

功能MRI诊断单纯疱疹病毒性脑炎一例

目的评价功能磁共振在单纯疱疹病毒性脑炎中的诊断价值。方法本例患者女性,45岁,行CT、MRI常规扫描及核磁血管成像、弥散加权成像、灌注成像,结合实验室检查、临床表现诊断单纯性疱疹性病毒性脑炎。结果发病当日CT平扫未见异常,6天后CT平扫右侧颞叶皮层大片状低密度,MRI右侧颞叶累及皮层、皮层下白质大面积长T1长T2高Flair信号,弥散加权成像呈高信号,ADC值较对侧低22%～36%,灌注成像右颞病变相对脑血流量及体积较对侧明显增高;MRA右侧大脑中动脉血管分支明显增粗、数目增多。结论当传统CT及MRI平扫及增强扫描难以鉴别脑梗死与脑炎时,功能MRI成像有助于单纯疱疹脑炎定性诊断。     

Herpes simplex virus encephalitis: chronic progressive cerebral MRI changes despite good clinical recovery and low viral load - an experimental mouse study

Cranial magnetic resonance imaging (MRI) is a sensitive diagnostic tool for the in vivo detection of morphological abnormalities in herpes simplex virus encephalitis (HSVE). We performed a long-term MRI study in a mouse model of HSVE. Cranial MRI findings were compared with the viral load within brain tissue, the presence of HSV DNA in the cerebrospinal fluid (CSF), a daily clinical assessment and post-mortem neurohistopathological studies. A 1.5 T cranial MRI scanner with standard spin-echo sequences was used. Viral load within the brain and the presence of HSV DNA in cerebrospinal fluid were determined by a polymerase chain reaction assay. Clinically, animals were severely affected within the first 2 weeks and recovered thereafter. Focal histopathological and MRI abnormalities involved predominantly limbic structures, a pattern that mimics human disease. Severity and extent of abnormalities had increased at 6 months despite clinical improvement. HSV DNA was present in CSF during the acute disease only. Brain viral load peaked at day 10 and declined thereafter. MRI as an in vivo monitoring approach may reveal chronic progressive changes in HSVE, despite clinical recovery and low viral load in the brain. Secondary, not directly virus-mediated, mechanisms of tissue damage may contribute to tissue damage of HSVE. Copyright Lippincott Williams & Wilkins     

儿童病毒性脑炎脑电图的波幅与预后观察

目的 :探讨儿童病毒性脑炎脑电图的波幅与预后的关系。方法 :对 2 8例儿童病毒性脑炎患者的脑电图波幅与预后、后遗症的发生率进行分析。结果 :病毒性脑炎患者的脑电图记录背景活动表现为低波幅慢活动异常者预后差 ,后遗症发生率高。结论 :对脑电图表现为低波幅慢活动异常的病毒性脑炎的患儿应及时积极的抗感染、护脑治疗 ,以减少后遗症的发生     

Arterial spin labeling perfusion imaging in an infant with anti-N-methyl-D-aspartate receptor encephalitis: A case report

BackgroundAnti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis characterized by complex neuropsychiatric syndromes and the presence of cerebrospinal fluid (CSF) antibodies against NMDAR. The characteristics of anti-NMDAR encephalitis in children, particularly infants, are unclear due to difficulties in neurologic assessment such as psychiatric symptoms. Additionally, subtle or non-specific findings of conventional magnetic resonance imaging (MRI) make early diagnosis even more difficult. Herein, we present the first case of infant anti-NMDAR encephalitis in which perfusion imaging demonstrated marked abnormalities and the absence of conventional MRI findings.Case presentationThe patient was an 11-month-old boy who was admitted because of seizure and prolonged fever. He presented with involuntary movements of the mouth and tongue. Brain MRI showed no morphological abnormalities, but three-dimensional arterial spin labeling (ASL) perfusion imaging showed reduced blood flow in the left temporal and frontal regions and the right cerebellum. After that, a positive anti-NMDAR antibody test result was received. Despite treatment with IVIG and methylprednisolone, the involuntary movements and autonomic dysfunction gradually became more prominent. After rituximab administration, the clinical symptoms improved slightly, and follow-up MRI revealed diffuse brain atrophy and improvement in the balance of brain perfusion.ConclusionsTo the best of our knowledge, this is the first case report of infantile anti-NMDAR encephalitis in which cerebral blood flow was evaluated using three-dimensional ASL perfusion imaging. Indeed, our case, which showed abnormalities only in ASL perfusion imaging, suggests that CBF assessment could aid in the early diagnosis of anti-NMDAR encephalitis in infants.