119例小儿病毒性脑炎临床分析

目的对小儿病毒性脑炎病例进行临床分析,总结临床诊断及治疗经验。方法我院儿科2013-01—2015-12收治小儿病毒性脑炎患儿119例,结合其临床表现及脑脊液检查、头颅CT、头颅MRI、脑电图(EEG)等相关检查,对小儿病毒性脑炎的诊疗及预后进行分析和总结。结果 119例病毒性脑炎患儿,给予控制体温、镇静止惊、降颅压、吸氧、营养脑细胞、纠正电解质紊乱及抗病毒等综合治疗,总有效116例(97.5%),3例(2.5%)继发癫痫或智力减退。结论小儿病毒性脑炎早期缺乏特异性临床表现,临床医生及早明确诊断和采取有效措施,对改善患儿预后至关重要。     

儿童病毒性脑脊髓膜炎临床表现及脑脊液和头颅CT检查临床分析

目的分析病毒性脑炎患儿的临床表现、脑脊液及头颅C T检查结果。方法分析2008-06-2011-06收住我院儿科治疗的174例病毒性脑炎患儿的临床表现、脑脊液及头颅C T检查。结果 4例头颅C T检查显示脑实质低密度影;全部患儿脑脊液常规、生化检查：正常34例（19.5%）;18例（10.3%）腰椎穿刺有损伤,脑脊液外观呈现微混～淡红色,其余外观均呈现无色透明状。蛋白质呈轻度增高者66例（37.9%）;有核细胞增多者128例（73.6%）,均以淋巴细胞为主;糖、氯化物均正常;脑脊液涂片及培养均未见细菌。结论病毒性脑炎患儿腰椎穿刺检查前,常规检查头颅CT;尽早行脑脊液常规、生化检查,有条件的尽量同时进行脑脊液细胞学检查,提高病毒性脑炎的诊断率。     

短程甲基强的松冲击疗法加干扰素治疗小儿病毒性脑炎

目的：观察短程甲基强的松冲击疗法加干扰素治疗小儿病毒性脑炎的疗效。方法收集小儿病毒性脑炎患儿34例,随机分对照组15例和观察组19例。对照组采用干扰素治疗,观察组采用短程甲基强的松冲击疗法加干扰素治疗。比较2组患儿临床症状改善时间及疗效。结果观察组发热、抽搐、脑膜刺激征、病理征、意识障碍、颅内高压的恢复时间均显著短于对照组（P＜0.05）。观察组总有效率94.74％,显著高于对照组的60.00％（P＜0.05）。结论短程甲基强的松冲击疗法加干扰素治疗小儿病毒性脑炎能有效缩短临床症状改善时间并提高疗效。     

自身免疫性脑炎临床鉴别诊断及治疗研究

目的分析自身免疫性脑炎的鉴别诊断及治疗措施。方法选取2015-01—2016-02我院治疗的病毒性脑炎患者为病毒性脑炎组,自身免疫性脑炎患者为自身免疫性脑炎组,每组50例,进行相关鉴别诊断;同时将自身免疫性脑炎患者按随机数字表法分为观察组(25例)与对照组(25例),观察组给予免疫球蛋白、激素治疗,对照组仅给予激素治疗。观察并比较自身免疫性脑炎的鉴别诊断及效果。结果自身免疫性脑炎组脑脊液蛋白质含量正常率(74.00%)、亚急性发作率(52.00%)、脑脊液与血清中抗NMDA抗体(54.00%)均高于病毒性脑炎组,影像学累及颞叶率(12.00%)低于病毒性脑炎组;观察组总有效率(84.00%)优于对照组(56.00%),差异具有统计学意义(P0.05)。结论自身免疫性脑炎大多亚急性发作,其脑脊液蛋白质含量基本正常,自身免疫性脑炎患者在脑脊液与血清中均存在不同程度的自身免疫性抗体,同时免疫球蛋白联合激素有更好的治疗效果。     

脑电图在小儿病毒性脑炎临床早期诊断中的应用价值研究

目的探析脑电图在小儿病毒性脑炎临床早期诊断中的应用价值。方法选取294例病毒性脑炎患儿为研究对象,根据患儿入院时间先后将其分为脑电图组(接受脑电图检查,n=98)、磁共振组(接受磁共振检查,n=98)、脑脊液组(接受脑脊液检查,n=98),对3组临床早期诊断价值进行对比分析和评价。结果脑电图组患儿临床早期诊断的阳性率为78.57%,磁共振组为31.63%,脑脊液组为27.55%。脑电图组诊断阳性率明显高于其他2组,组间对比差异具有统计学意义(P0.05)。结论在小儿病毒性脑炎临床早期诊断中,使用脑电图进行临床诊断的阳性率相对较高,可为临床治疗方案的确定提供重要数据支持,值得应用。     

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。     

单纯疱疹病毒性脑炎18例临床分析

目的探讨单纯疱疹病毒性脑炎（HSE）的临床表现、早期诊断及治疗。方法回顾18例HSE患者的临床资料并结合文献进行分析。结果HSE患者的临床表现以精神症状为主,大多数患者脑电图有异常表现,少数脑脊液病毒学检查阴性。结论HSE的诊断应以临床症状为主,同时结合脑电图（EEG）、脑脊液病毒学及影像学检查综合判断。EEG有利于早期诊断及疗效观察。治疗应以抗病毒治疗为主,同时结合免疫治疗。     

单纯疱疹病毒性脑炎30例脑脊液细胞学结果分析

目的进一步了解单纯疱疹病毒性脑炎病人的脑脊液细胞学特点及其应用价值。方法３０例病例均经免疫学（ＨＳＶ抗原检查和ＰＣＲ）和临床确诊,采用常规的脑脊液细胞玻片离心沉淀法收集细胞,经ＭＧＧ染色后在显微镜油镜下进行逐个细胞检查。结果仅１４例病例（４６６％）的常规脑脊液白细胞计数有增高,而脑脊液细胞学检查全部病例均有异常,且以淋巴细胞比例升高为主的淋巴细胞反应为多见（６６７％）。结论单纯疱疹病毒性脑炎的常规脑脊液细胞学检查的异常率高于常规脑脊液白细胞计数检查,且符合以淋巴细胞比例升高为主的一般病毒性脑炎的脑脊液细胞学异常规律。故具有一定的临床诊断和鉴别诊断价值。脑脊液细胞计数的高低和脑脊液细胞学异常的类型似与ＨＳＶ类型无关     

病毒性脑炎脑脊液细胞学检查的诊断价值

病毒性脑炎是常见的中枢神经系统病毒感染性疾病 ,随着病毒学及免疫学的发展已证实和鉴定了很多种病毒性脑炎 ,然而 ,病毒性脑炎的病因、发病机制、诊断及治疗等方面尚有许多问题有待研究。就诊断而言 ,目前对病毒性脑炎的检查诊断方法很多 ,脑脊液细胞学检查就是其中之一 ,现将我院 1988～ 2 0 0 1年收治的 32 4例病毒性脑炎患者脑脊液细胞学检查结果并结合临床进行对照研究 ,以探讨其诊断价值。资料与方法一般资料　病毒性脑炎组 32 4例 ,男 188例 ,女136例 ,年龄 2～ 6 9岁 ,平均 31岁。全年发病 ,无明显季节性 ,呈急性或亚急性起病 ,病…     

大剂量γ干扰素治疗病毒性脑炎疗效观察

目的观察大剂量γ干扰素治疗病毒性脑炎的临床疗效。方法选择我院2008-05～2011-05收治的82例病毒性脑炎患儿进行回顾性分析,其中42例患儿加用γ干扰素100万U/d,5～7 d一疗程,并与同期住院的40例病毒性脑炎患儿疗效对比。结果治疗组在发热、头痛呕吐、神经精神症状及脑脊液转阴时间差异具有统计学意义(P<0.01)。结论大剂量γ干扰素治疗病毒性脑炎值得临床推广应用。     

抗NMDA受体脑炎1例报道并文献复习

目的探讨抗NMDA受体脑炎的发病机制、临床表现、辅助检查、及治疗方法。方法报道本院确诊的1例患者的临床资料并复习国内外相关文献。结果本例患者以发热为首发症状,后出现癫癎、精神行为异常、意识障碍、口-面-舌部的异常运动,经脑脊液和血液检测出抗NMDAR抗体,确诊为抗NMDA受体脑炎,经激素及丙种球蛋白治疗后患者基本恢复正常。结论抗NMDA受体脑炎是一种少见的新型自身免疫性脑炎,好发于青年女性,主要表现为癫癎、精神症状、意识障碍、口-面-舌的异常运动等,脑脊液抗NMDAR抗体检测阳性可确诊本病,激素、丙种球蛋白、血浆置换为该病的一线治疗,早诊断、早治疗后大多患者预后良好。     

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.     

Coxsackie A9 focal encephalitis associated with acute infantile hemiplegia and porencephaly.

The factors underlying acute infantile hemiplegia are seldom identified. Coxsackie A9 focal encephalitis was documented for the first time in a 3-month-old infant with fever, hemiconvulsions, and hemiplegia followed by a static motor deficit and epilepsy. It has been suggested that the acute infantile hemiplegia associated with encephalitis results from an arteritis or venous sinus thrombosis with subsequent cerebral infarction. However, this was not observed in our patient. Rather, a series of brain scans, computerized tomograms, and a cerebral angiogram clearly documented the evolution of a focal necrotizing encephaloclastic process resulting in a porencephalic cyst. Serial cerebrospinal fluid viral cultures were necessary to isolate the etiologic agent (tcoxsackie A9). The infant did not have a neutralizing antibody response to the infecting viral agent despite an apparently intact immune system, which possibly may be explained by the developed of immune tolerance or an insufficient amount of infecting viral antigen. This emphasizes that serologic studies alone may not be adequate to document an acute central nervous system viral infection. This patient also typifies the poor prognosis in infants presenting with acute hemiplegia, fever, and convulsions in the absence of cerebrovascular occlusion.     

60例急性病毒性脑炎的临床分析

目的　急性病毒性脑炎的临床治疗。方法　收集 1993年～ 2 0 0 1年 6月份以前的住院病历 6 0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 抗病毒药组之间的疗效关系进行分析。结果　本组病毒性脑炎可分 6种临床类型 :精神异常 ;持续性剧烈头痛伴呕吐 ;强直一阵挛性抽搐 ;持续性意识障碍 ;脑神经损害、失语、偏瘫 ;小脑性共济失调等发病形式。经统计学处理 ,单用激素组与激素 抗病毒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ADEM或MS作鉴别     

^18F-FDG PETCT在抗NMDA受体脑炎及病毒性脑炎诊断中的价值

抗N-甲基-D-天冬氨酸(NMDA)受体脑炎及病毒性脑炎的临床表现相似但治疗方法及预后不同,故早期鉴别至关重要。抗体检测及病原学检测存在延时、假阴性等不足,常规辅助检查缺乏特异性,鉴别价值有限。^18F脱氧葡萄糖(FDG)标记的正电子发射计算机断层显像(PETCT)检查对于抗NMDA受体脑炎早期代谢异常敏感性高,存在特征性的枕叶低代谢和额颞叶高代谢。病毒性脑炎行^18F-FDG PETCT检查研究病例数较少,不同病毒性脑炎的脑代谢表现不同,但均无特征性的枕叶代谢减退。本文现围绕NMDA受体脑炎及病毒性脑炎行^18F-FDG PETCT检查时的脑代谢特点综述如下。     

疱疹病毒性脑炎的早期诊断方法研究

目的探讨不同检测手段对早期诊断疱疹病毒性脑炎（ＨＶＥ）的价值。方法应用间接荧光抗体法（ＩＦＡ）、聚合酶链反应（ＰＣＲ）检测ＨＶＥ患者脑脊液中的抗疱疹病毒ＩｇＭ抗体和疱疹病毒核酸；应用免疫细胞化学（ＩＣＣ）、原位杂交（ＩＳＨ）和ＰＣＲ检测ＨＶＥ患者脑活检组织中的疱疹病毒抗原和核酸。结果６４例患者脑脊液中５４例抗疱疹病毒ＩｇＭ抗体阳性，５０例ＰＣＲ阳性，其中４０例两者均为阳性。１２例脑组织中１０例ＰＣＲ阳性，４例ＩＳＨ阳性，６例ＩＣＣ阳性。结论抗疱疹病毒ＩｇＭ抗体检测最敏感，以下依次为ＰＣＲ、ＩＣＣ、ＩＳＨ诊断疱疹病毒性脑炎，联合应用以上几种检测手段有助于提高早期诊断ＨＶＥ阳性率。     

Cerebral vasculitis secondary to Varicella-Zoster virus infection

INTRODUCTION: Central nervous system infection by the varicella-zoster virus (VZV) can be responsible for myelitis, meningitis, ventriculitis and large and small-vessels encephalitis. CASE REPORT: We report the case of a 57-year-old-man hospitalized for deteriorating general health. Physical examination revealed likely encephalitis associated with headache without meningeal syndrome. Successive cerebral MRIs showed bilateral necrosis of the amygdaloid bodies and multiple deep and sub-cortical infarcts suggestive of vasculitis. Cerebral arteriography was normal. Three cerebral fluid examinations disclosed mononuclear pleiocytosis with few red blood cells. PCR analysis for VZV was only positive at the third time. DISCUSSION: The diagnosis of VZV encephalitis is difficult without the rash typical of zoster and because of the low sensitivity of PCR VZV in comparison with PCR HSV. CONCLUSION: In active viral disease, where the prognosis depends on early treatment, we highlight the usefulness of repeated PCR analysis and the search for antibodies in blood and cerebrospinal fluid.     

Non‐paraneoplastic limbic encephalitis and central nervous HHV‐6B reactivation: Causality or coincidence?

Autoantibody‐related encephalopathies represent an important differential diagnosis in adult onset epilepsy. Here, we report the case of a 25‐year‐old patient with new‐onset epilepsy and psychotic syndrome, who underwent biopsy resection for etiological classification. MRI analysis and neuropathological examination showed a T‐lymphocytic dominated encephalitis with involvement of the limbic system. An indirect immunohistochemistry approach identified autoantibodies against glutamic acid decarboxylase (GAD) in cerebral spinal fluid and serum, which were confirmed by affinity purification / mass spectrometry analysis. Further examinations revealed evidence of chromosomally integrated human herpes virus type 6B (HHV‐6B). However, astrocytic expression of HHV‐6 lytic protein was detected by double immunofluorescence analysis. The cerebral expression of HHV‐6 antigen, a clinical improvement under antiviral therapy as well as an initial finding of HHV‐6 IgM antibodies strongly argue for an additional active HHV‐6B infection. Review of the literature reveals singular reports of patients with GAD antibody‐positive limbic encephalitis and central nervous system infections with HHV‐6B. Since herpes simplex virus encephalitis has been recently reported as a trigger of N‐methyl‐D‐aspartate receptor antibody encephalitis, it is tempting to speculate that HHV‐6B infections may trigger a non‐paraneoplastic form of limbic encephalitis in a parallel cascade.     

Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis.

Three children ranging in age from 2 to 5 years with acute disseminated encephalomyelitis (ADEM) were successfully treated with high-dose intravenous immunoglobulin (IVIG). Their symptoms were somnolence, fever, headache, vomiting, and resting tremor. In all of these patients, it was difficult to distinguish the condition from viral encephalitis before analyzing the myelin basic protein. ADEM was diagnosed because of increased levels of myelin basic protein in their cerebrospinal fluid and abnormal high-signal intensity on T2-weighted magnetic resonance imaging. All patients were given IVIG at a dose of 400 mg/kg/day for 5 consecutive days. The patients rapidly regained consciousness in 14 hours, 2 days, and 4 days and demonstrated a complete clinical improvement within 18 days, 10 days, and 7 days of the initiation of the treatment, respectively. IVIG may prove useful as an alternative treatment to corticosteroids for ADEM.     

磁共振成像及脑脊液细胞学对病毒性脑(膜)炎的诊断性研究

目的探讨MRI和脑脊液细胞学检测阳性率、异常程度和发病时间对病毒性脑(膜)炎诊断和制定治疗方案的指导价值。方法回顾189例病毒性脑(膜)炎患者的头部MRI及脑脊液检查资料,分析MRI正常或异常患者在疾病早期的脑脊液细胞学改变。结果 189例患者中96例(50.79%)呈现MRI异常影像、129例(68.25%)脑脊液细胞学检测异常。MRI异常患者中脑脊液细胞学检测异常率为72.92%(70/96),与MRI正常患者(63.44%,59/93)比较差异具有统计学意义(P=0.000)。结论病毒性脑(膜)炎患者在疾病早期MRI改变晚于脑脊液细胞学改变,但二者对提示诊断和制定治疗方案均具有重要临床意义。