单纯疱疹病毒性脑炎20例临床诊治分析

目的探讨单纯疱疹病毒性脑炎的临床早期诊断与治疗方法。方法回顾性分析20例单纯疱疹病毒性脑炎的临床资料。结果（1）20例均为急性或亚急性起病;（2）临床多以头痛、发热、记忆减退、精神异常、癫痫发作伴或不伴意识障碍为首发症状;（3）头颅MRI检查比CT敏感,早期可见单侧或双侧颞叶、额叶、顶叶或岛叶呈异常高信号;（4）脑电图出现中度异常脑波,多呈颞额部偏胜、周期性棘-慢波;（5）脑脊液细胞学以淋巴细胞反应为主,部分病例可见大量红细胞;（6）更昔洛韦及高压氧疗的应用疗效显著。结论根据早期临床表现、影像学特征、脑电图、脑脊液检查可以拟诊单纯疱疹病毒性脑炎,早期应用更昔洛韦,结合高压氧治疗可显著改善其预后。     

55例病毒性脑炎脑电图诊断分析

目的探讨脑电图（EEG）对病毒性脑炎的诊断价值。方法回顾分析55例病毒性脑炎患者的I临床资料和检查结果。结果所有病例均在入院当天内做了脑电图检查,异常53例（96．36％）,其中轻度异常33例,中度异常15例,重度异常5例。经过治疗后复查脑电图．脑电图好转情况和临床好转情况相吻合。结论病毒性脑炎患者脑电图异常率高,脑电图检查对儿童病毒性脑炎的诊断具有重要的价值。     

病毒性脑炎继发癫痫患者临床特点及影响因素分析

目的：探讨病毒性脑炎继发性癫痫患者的临床特点,以提高对该病的认识。方法回顾性分析46例病毒性脑炎继发癫痫患者的临床资料。结果：46例病毒性脑炎继发癫痫患者中37例出现影像学异常,异常率为80％。癫痫发作类型：全身性强直一阵挛发作19例（41．3％）、单纯部分性发作6例（13．04％）、复杂部分性发作7例（15．22％）、部分性发作继发全面性8例（17．39％）、持续状态6例（13．04％）。脑电图表现：呈边缘脑电图4例（8．7％）、轻度异常8例（17．39％）、中度异常20例（43．48％）、重度异常14例（30．43％）、首次脑电图检测出现癫痫波（尖波、棘波、棘一慢波综合）14例（30．43％）。结论：病毒性脑炎易继发癫痫,MRI提示额、颞叶、皮层、海马等部位受累以及EEG提示中、重度异常与癫痫明确相关。     

探讨儿童脑电图儿童病毒性脑炎的早期诊断和预后评估方面临床研究

目的探讨脑电图在儿童病毒性脑炎的早期诊断和预后评估方面临床研究价值。方法对115例儿童病毒性脑炎患者的脑电图和临床资料进行全面分析研究：97例为脑电图异常,异常率为84.34%。轻度异常51例（44.34%）,中、重度异常46例（40%）。结果治疗2-4周后,脑电图恢复正常81例,未恢复正常11例：轻度异常1例,中度异常6例,4例有明显的意识障碍,1例有经常发作性脑电图异常改变。脑电图异常改变表现为弥漫性慢波,α波节律减弱,或以θ波为主,其中一部分患儿有局限性异常脑电图表现。结论脑电图作为一种检查手段,脑电图异常改变与临床症状、大脑脑实质损伤的严重程度成正向关系,因此脑电图对儿童病毒性脑炎的早期诊断和临床预后评估有着非常重要的正相关性。     

小儿病毒性脑炎100例临床分析

本文对１００例小儿病毒性脑炎临床症状及脑脊液病毒学，脑电图改变做初步探讨，发现：（１）在单纯疱疹病毒脑炎（ＨＳＥ）的临床表现中，意识障碍的发生率显著高于非单纯疱疹病毒脑炎（ＮＨＳＳＥ），提示的病原学诊断对于早期诊断及指导临床治疗具有重要意义。（２）病毒性脑炎脑电图异常率为８４．３％（７０／８３），说明病毒性脑炎患者大多数有脑电图改变，但脑电图的改变与疾病的轻重并不呈完全正相关。     

42例小儿急性病毒性脑炎所致继发性癫痫的临床分析

目的:探讨小儿急性病毒性脑炎所致的继发性癫痫的临床症状及体征。方法:对小儿急性病毒性脑炎出现继发性癫痫分别从脑电图(EEG)、头颅CT及MRI进行分析。结果:在出现继发性癫痫的小儿急性病毒性脑炎的脑电图描记中,均表现出弥漫性低幅或高幅慢波或慢活动的异常脑电图,其中约91.0%出现局灶性慢波灶或慢波减弱区或典型的癫痫样放电;头颅MRI及CT检出继发性癫痫病灶的阳性率分别为90.9%及58.1%。结论:常规脑电图检查可以作为重要的临床检查方法,可用于判断急性病毒性脑炎所致的继发性癫痫,头颅检查继发性癫痫MIR检查的价值明显优于CT检查。     

67例儿童病毒性脑炎临床分析

目的通过儿童病毒性脑炎的临床分析来增强对本病的认识。方法总结我院儿科2014年3月~2014年9月收治的病毒性脑炎患儿67例,对临床表现、体征、辅助检查、治疗方法和疗效进行分析。结果儿童病毒性脑炎的临床表现以发热、头痛、呕吐为主,阳性体征较少。本组外周血白细胞数异常33例(43.3%),脑脊液异常56例(83.6%),脑电图异常36例(53.7%),头颅影像学异常9例(13.4%)。结论儿童病毒性脑炎的临床表现具有某些特征性,脑电图、脑脊液、头颅影像学辅助检查对诊断具有重要意义,尤其是脑电图检查。     

儿童病毒性脑炎68例临床分析

目的分析儿童病毒性脑炎的临床特点及治疗方案。方法对某院儿科收治的68例病毒性脑炎患儿临床症状、体征,脑脊液常规和生化检查,脑电图与CT结果进行综合分析。结果68例患儿中有60例(88.24%)病前有其他部位感染;其临床表现:均有发热,呕吐48例(70.59%),头痛41例(60.29%),头痛伴腹痛20例(29.41%),惊厥23例(33.82%),抽搐持续状态5例(7.35%),昏迷3例(4.41%),精神症状40例(58.82%),意识障碍19例(27.94%),合并脑膜刺激征和病理征32例(47.06%),肢体瘫痪3例(4.41%),失语1例(1.47%);脑脊液检查异常48例(70.59%),脑电图异常50例(73.53%),36例头颅CT平扫异常8例。采用止惊、退热、降低颅高压等综合治疗加抗病毒治疗,临床治愈53例,好转11例,放弃治疗3例,病死1例。结论小儿病毒性脑炎临床表现呈多样化,早期诊断、及时治疗是治疗成功的关键。     

小儿散发性病毒性脑炎临床特点及脑电图改变

目的了解近年小儿散发性病毒性脑炎的临床特点及脑电图改变。方法总结分析１９９２年１月至１９９７年１２月收治的１５０例小儿散发性病毒性脑炎。结果男９０例，女６０例，＞５岁１０６例，８、９、１０月份发病５７例。有发热１４４例，呕吐１０９例，头痛９１例，惊厥５４例，巴氏征（＋）和／或脑膜刺激征（＋）１３１例。９４例行腰穿检查，脑脊液细胞数和／或蛋白质升高４５例。１３８例脑电图中，异常１３６例。２１例行头颅ＣＴ和／或ＭＲＩ检查，异常１３例。治愈１４１例，好转９例，无死亡。结论小儿散发性病毒性脑炎的预后良好，脑电图在小儿散发性病毒性脑炎诊断中有重要作用。     

20例病毒性脑炎患者的临床表现及磁共振特点分析

目的：分析毒性脑炎患者的临床表现及磁共振特点,探讨其对病毒性脑炎的诊断价值。方法回顾性分析20例病毒性脑炎患者临床表现及磁共振特点。结果临床表现：（1）前驱感染：患者起病前有上呼吸道感染症状12例,以腹泻起病8例。（2）首发症状：17例发热,伴头痛14例(70%),恶心呕吐9例(45%)。13例精神行为异(65%),7例癫痫发作(35%)。11例颈强直(55%)。5例肢体瘫痪(25%),其中3例单瘫,2例偏瘫。头颅MRI检查20例患者中异常19例,异常率为96.72%,异常主要表现：双或单侧海马、岛叶、扣带回等或长T1、T2异常信号,明显显示压水像病灶。单发病灶5例,多发病灶15例。病灶表现为T1WI低信号,T2WI高信号。结论头颅MRI检查异常率高,结合临床表现,对病毒性脑炎的早期诊断有一定的帮助。     

以精神障碍为主要临床表现的53例散发性脑炎分析

该文报告以精神障碍为主的散发性脑炎53例。其中兼有精神运动性抑制和精神运动性兴奋两类症状者35例(66.0%),单纯精神运动性抑制症状者12例(22.6%),单纯运动性兴奋者6例(11.3%),有意识障碍者38例(71.4%),脑炎液异常者21例(45.7%),脑电图异常者35例(87.5%),41例(77.4%)早期被误诊。结果表明,以精神障碍为主的散发性脑炎临床表现酷似功能性精神疾病,容易误诊,值得注意。     

影响病毒性脑炎近期预后的相关危险因素分析

目的 探讨影响病毒性脑炎近期预后的相关危险因素.方法 回顾性分析124例病毒性脑炎患者的临床资料,应用格拉斯哥预后量表(COS)分级将患者分为预后良好组(89例)和预后不良组(35例).并选取14个危险因素进行Logistic回归分析.结果 单因素分析表明,抽搐持续时间、意识障碍、局灶性神经功能缺损,头颅MRI异常、脑电图重度异常与病毒性脑炎近期预后有显著相关性(P＜0.05);而年龄、性别、精神行为异常、脑膜刺激征、脑脊液(CSF)压力、CSF白细胞数、CSF蛋白、外周血白细胞计数、头颅CT异常与病毒性脑炎近期预后无显著相关性(P＞0.05).多因素分析表明,抽搐持续时间(OR=2.877,P=0.005)和头颅MRI异常(OR=16.582,P=0.008)为影响病毒性脑炎近期预后的独立危险因素.结论 病毒性脑炎的预后是多因素共同作用的结果,头颅MRI异常和抽搐持续时间是影响病毒性脑炎近期预后的独立危险因素.

Abstract：

Objective To investigate the risk factors of short-term prognosis in patients with viral encephalitis. Methods Clinical data of 124 patients with viral encephalitis were analyzed retrospectively. All patients were divided into good prognosis group and poor prognosis group according to the Glasgow outcome scale. Fourteen related risk factors were chosen and multifactor Logistic regression analysis was made. Results Univariate analysis showed, the duration of seizure, consciousness disorder, deficiency of cranial nerves, severe abnormal electroencephalogram and abnormal cranial MRI had significant correlation with short-term prognosis (P＜0.05), but age, sex,behavior disorder, meningeal irritation sign, pressure of cerebrospinal fluid (CSF), leukocyte number of CSF, protein level of CSF, peripheral white blood cell, and abnormal cranial CT had no correlation with short-term prognosis (P ＞0.05). Multivariate analysis showed that the abnormal of cranial MRI and the duration of seizure were the independent risk factors of short-term prognosis. Conclusions The short-term prognosis of viral encephalitis relates with many factors. The abnormal cranial MRI and the duration of seizure are the important related risk factors.     

龙岩市764例儿童病毒性脑炎流行病学特征分析

目的分析龙岩市儿童病毒性脑炎（EV）流行病学特征,为制定防治策略提供依据。方法对2004—2011年764例患者进行流行病学、临床表现和检查分析。结果病例无聚集现象,以≤7岁为主,男性较多,5~7月为发病高峰。患儿多出现发热（86.1%）、头痛（64.8%）、呕吐（61.5%）、颅内压增高（72.4%）、脑脊液白细胞数增加（58.4%）、脑电图异常（79.0%）;脑积液病毒分离阳性率18.6%,以埃可病毒（ECV）为主（90.1%）。2004和2010年的暴发疫情分别由ECV19和ECV6引起。结论病毒性脑炎多散在发生,临床表现以无菌性脑膜炎为主,实验室检查有利于病例诊断。ECV是主要病原体,ECV30为当地持续流行的毒株。     

脑电图在小儿病毒性脑炎诊治中的价值

目的 评价脑电图(EEG)在病毒性脑炎诊断治疗中的价值。 方法 分析62例病毒性脑炎患儿的EEG特点,并与其脑脊液、头颅CT检查结果作比较、分析。 结果 病毒性脑炎早期EEG异常率明显高于脑脊液、头颅CT,差异有显著性(P<0.05)。病情严重者EEG呈中重度异常,病情轻者EEG呈轻中度异常,差异有显著性(P<0.05)。脑电图呈重度异常者其预后较差,脑电图呈轻中度异常者其预后较好,差异有显著性(P<0.05)。 结论 EEG在小儿病毒性脑炎的早期诊断、病情判断、预后评估方面均具有较高的临床价值,可广泛应用。     

An unusual cause of meningo-encephalitis: Japanese encephalitis

Two women, 29 and 30 years of age, who had visited Indonesia and Thailand, respectively, during the summer, presented with diarrhoea, headache, fever and later neurological symptoms. The first patient had to be sedated because of restlessness and was admitted to the intensive-care unit for intravenous antimicrobial therapy; the second became comatose and received intravenous rehydration and antipyretics. No diagnosis was made during the acute phase ofthe illness, but later there was serological evidence of Japanese encephalitis. Both patients recovered, but memory and concentration difficulties persisted for a long time. Due to the increase in travelling, we see more and more cases of (rare) imported diseases. Japanese encephalitis is a viral infection that causes 50,000 cases each year in Asia with a mortality of 30%. The risk of transmission for tourists is very low. Most infections with Japanese encephalitis virus do not lead to symptomatic disease; only 0.1-5% of infections lead to clinical disease. The symptoms are initially non-specific, consisting of general discomfort and diarrhoea. After this, patients can develop headache, decreased consciousness and sometimes convulsions. Therapy consists of supportive care. For travellers at high risk of exposure, a formalin-inactivated vaccine is available. For the proper diagnosis of rare imported diseases, it is advisable to consult an infectious-disease specialist or microbiologist at an early stage when evaluating a patient who has recently returned from the tropics.     

Varicella zoster virus infection of the central nervous system in a tertiary care center in Lebanon

ObjectiveTo describe the clinical manifestations and treatment outcomes of patients with VZV meningitis and encephalitis consulting at two medical centers in Lebanon.MethodsRetrospective study of patients with VZV meningitis and/or encephalitis confirmed by positive cerebrospinal fluid (CSF) VZV PCR.ResultsTwenty patients were identified (13 males). The average age was 49.7 ± 22.2 years. The most common complaint was headache (n = 17/20). Common comorbidities included hypertension (n = 7/20) and diabetes mellitus (n = 5/20). Immunosuppression was reported in two patients. Vesicles were only observed in eight patients. Altered mental status, focal neurological deficits, and fever were documented in six, two, and four patients respectively. All patients had CSF leukocytosis with lymphocytic predominance, normal CSF/serum glucose ratio, and high CSF protein. Eighteen patients had brain CT scans showing no relevant findings. Two of 12 patients with brain MRI had focal abnormalities. Unilateral temporal slow waves were observed in three of four patients who underwent electroencephalograms. Four patients had encephalitis and 16 had meningitis. Eighteen patients received an antiviral therapy. Treatment either included intravenous acyclovir or oral valacyclovir. The encephalitis and meningitis groups had comparable mean duration of treatment (13.5 ± 6.6 vs. 12.2 ± 5.4, respectively). All admitted patients showed clinical cure with no reported neurological sequelae.ConclusionVZV infection should be suspected in any patient with signs and symptoms of viral meningitis or encephalitis, irrespective of age, immune status, presence or absence of vesicles, fever, or neck stiffness.