Evoked potentials in severe herpes simplex encephalitis

Diagnostic and prognostic value of evoked potentials (EP) were studied in 5 patients with severe herpes simplex encephalitis (HSE). Latency of the third negative cortical N70 peak, elicited by median nerve stimulation, was prolonged in 3 survivors with Glasgow coma score of 6 (115 vs 71 ms in controls,p<0.05), but normal after improvement of the acute disease, N70 right to left interhemisphere difference was increased initially in the 4 survivors (26 vs 3 ms in controls,p<0.05) indicating focal brain involvement, a crucial finding in HSE. The first cortical N 20 peak was preserved in all survivors even during deep coma where evaluation of brain function is difficult. Auditory brainstem EP were normal in all patients and useful to exclude brainstem death. In severe HSE, somatosensory long-latency EP are an effective monitor of the level of impaired consciousness and can detect brain focal signs. Short-latency N20 components may be predictive of the outcome.The study was supported by the Fonds zur Förderung der wissenschaftlichen Forschung P7382M     

Psychosis and herpes simplex encephalitis

We have reported an unusual presentation of herpes simplex encephalitis in a patient with a 3 1/2-year history of a schizo-affective disorder. In the month immediately before diagnosis, the patient lost contact with reality and became violent. After successful treatment with antipsychotic medication, he had agitation and disorientation, as well as fever and cerebrospinal fluid pleocytosis. There were no focal neurologic findings. When a low-density lesion in the right temporal lobe was defined by computerized axial tomography, brain biopsy and culture isolated herpes simplex virus type 1. After therapy with vidarabine, the patient regained independence in simple daily activities. This case stresses the possibility of herpes simplex encephalitis in patients with an acute mental change.     

Valacyclovir for herpes simplex encephalitis

The recommended treatment for herpes simplex encephalitis (HSE) remains intravenous acyclovir. In resource-poor countries, however, intravenous formulations are usually unavailable or unaffordable. We report the penetration of acyclovir into the cerebrospinal fluid (CSF) in patients with HSE, treated with the oral prodrug valacyclovir at 1,000 mg three times daily. The oral therapy achieved adequate acyclovir concentrations in the CSF and may be an acceptable early treatment for suspected HSE in resource-limited settings.     

Voxel-based morphometry of herpes simplex encephalitis

Voxel-based morphometry (VBM) is a powerful tool for analyzing changes in gray or white matter density of the brain. By using an automated segmentation procedure and standardized parametric statistics it avoids biases inherent in operator-dependent morphological operations (J. Ashburner and K. J. Friston, 2000, NeuroImage 11, 805-821). Since its introduction in 1995, VBM has been used to examine anatomical changes in a variety of diseases associated with neurologic and psychiatric dysfunction. Given the power of this technique for discerning subtle anatomical changes, we wanted to assess its performance on brains with gross structural abnormalities. Such results could have implications regarding the difficulties to be faced when examining other types of distorted brains (e.g., brains with changes due to degenerative disease). This report describes the use of VBM for examining individual and group changes in gray matter concentration in five patients who had recovered from herpes simplex encephalitis (HSE) compared with age- and sex-matched controls. Because HSE tends to affect a specific set of brain regions we thought that this would (1) provide an opportunity to assess the anatomical face validity of VBM, (2) allow us to assess the problems of this technique when used on distorted brains, and (3) provide an in vivo demonstration of the gray matter changes due to HSE. We found that, despite problems in normalizing and segmenting these severely distorted brains, VBM was able to identify correctly a number of the regional gray matter abnormalities in HSE. The results, while consistent with the well-known histopathology of the disease, also demonstrate potential difficulties with this method.     

Atypical manifestations of herpes simplex encephalitis

The diagnosis of herpes simplex encephalitis is readily considered in patients with focal findings on neurologic and radiologic examinations. In the two patients we have described, the diagnosis was delayed because clinical findings were attributed to other medical conditions, and radiologic studies were nondiagnostic. A high index of suspicion and repeated neuroradiologic tests are recommended in patients with unexplained encephalitis.     

MELAS误诊为单纯疱疹病毒性脑炎一例

线粒体脑肌病伴高乳酸血症和卒中样发作（MELAS）是母系遗传性线粒体疾病,临床表现多样,易与单纯疱疹病毒性脑炎（HSE）混淆。该文报道1例初诊时误诊为HSE的MELAS患者,该例患者因反复发热、头痛、肢体抽搐1个月,再发头痛1周就诊,入院时初步疑诊为HSE,予以抗病毒治疗无效,进一步行血液和尿液基因检测确诊为MELAS。MELAS可与不典型的HSE表现相似,应谨慎鉴别。脑脊液和（或）血清乳酸升高和基底节钙化有助于诊断MELAS,MELAS的线粒体DNA突变可通过血液和尿液基因检测,而不需要采用肌肉活组织检查这样的有创检查。     

单纯疱疹病毒性脑炎8例病例分析

目的探讨单纯疱疹病毒性脑炎(HSE)的临床表现、辅助检查、诊断及治疗,提高HSE的早期诊断和治愈率。方法回顾8例HSE患者的临床表现,脑电图、影像学、脑脊液检查结果及治疗,并结合相关文献进行分析。结果 HSE患者均急性或亚急性起病,主要临床表现为发热、头痛、意识及精神障碍。头颅MRI、脑电图检查有利于早期诊断。脑脊液HSV-1 IgM抗体阳性及PCR DNA检测发现该病毒DNA可确诊。结论通过HSE的临床特点,结合脑电图、脑脊液及影像学检查,对HSE作出早期诊断,尽早使用抗病毒治疗是改善预后的关键。     

Transient global amnesia secondary to herpes simplex viral encephalitis

Sir, A 39-year-old company director had been under recent financialstress. On the day of hospital admission, he had been at hisdesk for an hour without complaint. Colleagues witnessed himsuddenly becoming distressed, and, although he was not directlyspoken to, he left the office and drove three miles home. Onarrival, his     

脑电图对单纯疱疹病毒性脑炎的早期诊断和预后评价

目的 探讨单纯疱疹病毒性脑炎(HSE)的脑电图构型和预后的关系。方法回顾性分析26例HSE患者的脑电图，并与CT、MRI和临床结局进行对照。结果CT、MRI和脑电图异常率分别为53．8％、66．7％和92．3％。异常脑电图构型：弥漫性慢波16例，额颞区慢波5例，周期波5例。结论脑电图检查有助于HSE的早期诊断和预后评价。     

Carbamazepine as therapy for psychiatric sequelae of herpes simplex encephalitis

We have presented a case of herpes simplex encephalitis that is interesting in that seizure activity was detected in mesial temporal structures, without manifestations of seizure activity except for severe emotional lability with explosive emotional outbursts. Response to carbamazepine (Tegretol) included marked reduction in EEG-detected seizure activity and in the frequency of emotional outbursts, extending to one year after treatment.     

小儿单纯疱疹病毒性脑炎13例临床分析

目的：探讨阿昔洛韦(ACV)与大剂量静脉丙种球蛋白(HDIVIG)联合治疗单纯疱疹病毒性脑炎(HSVE)的疗效。方法：对确诊HSEl3例进行回顾性临床分析，用HDIVIG治疗者，剂量200mg／kg／d，连用3～5天。结果：平均住院天数明显缩短，临床症状和体征消失快，疗程短，于发病2周内使用效果最好，对病程超过2周且头颅CT有低密度灶者疗效欠佳。     

1例不典型单纯疱疹病毒性脑炎病人的护理

单纯疱疹病毒性脑炎(herpes simplex virus encephalitis,HSE)是由单纯疱疹病毒(HSV)引起的中枢神经系统常见的病毒性脑炎,发病率国外报道约占人群的4/10万～8/10万[1],病死率高达70%,仅10%的病人可恢复正常生活能力.近期我科成功救治1例不典型单纯疱疹病毒性脑炎病人,现将护理介绍如下.     

Frontal impairment and confabulation after herpes simplex encephalitis: A case report

We describe the rehabilitation training of a 53-year-old woman with severe confabulatory and dysexecutive syndrome, as well as memory impairment, after herpes simplex encephalitis (HSE). Secondary narcolepsy was also present. Neuropsychologic deficits were detailed through an extensive examination, and specific techniques were used to improve performances in each defective cognitive domain. Improvement of vigilance and attention was reached through appropriate and timed periods of rest, along with attentional tasks of growing difficulty. Different external aids were used to reduce temporal disorientation, to contrast confabulation and inertia, and to overcome memory deficits in everyday life. Their independent use by the patient was implemented through cues that were progressively reduced. Treatment also focused on planning, categorization, and topographic orientation. The patient's family gave constant support during rehabilitation and provided informal training after discharge. The patient was able to regain independence in everyday life at home.     

A distinctive clinical EEG profile in herpes simplex encephalitis.

Two patients with herpes simplex encephalitis had clinical courses consisting of an acute febrile illness with early onset of seizures and rapidly progressive neurologic signs evolving to coma and death within 3 weeks. The electroencephalograms of both patients were similar and showed widespread, periodic, stereotyped sharp-and-slow-wave complexes occurring bilaterally over both hemispheres, as well as transient episodes of electrographic seizure activity occurring unilaterally, with suppression of the periodic activity on that side. Although the electroencephalographic findings are not pathognomonic, when associated with an acute encephalitic process, they would suggest the diagnosis of herpes simplex encephalitis.     

Serodignosis of herpes simplex encephalitis by antibody capture enzyme-linked immunosorbent assay

The sensitivity of a herpes simplex virus (HSV) IgG capture enzyme-linked immunosorbent assay was tested in 103 cerebrospinal fluid (CSF) and serum samples from 47 patients with herpes simplex encephalitis (HSE). Significant differences between CSF and serum absorbances were found in all HSE patients; earlier in three out of 30 patients by the capture technique than by the indirect ELISA. In follow-up samples with exceedingly high anti-HSV activity, maximal absorbance values were found in CSF and serum resulting in falsely-negative absorbance differences. Reanalysis with a lower concentration of capture anti-IgG solved the problem. This lower anti-IgG concentration was found suboptimal for analysis of early specimens. The specificity was tested in specimens from 115 patients without intrathecal anti-HSV production as determined by indirect ELISA. Five out of 73 patients with focal encephalitis of non-HSV origin had low level positive capture results. Four of them had varicella zoster (VZ) meningoencephalitis. Severe blood-CSF barrier damage did not interfere in seven patients tested. The IgG-capture was found advantageous to the indirect technique as the results were more sensitive and clearcut. It is less labour intensive and may be completed within five to six hours.