Herpes simplex encephalitis: treatment with surgical decompression and cytosine arabinoside.

Herpes simplex encephalitis in a 21-year-old man presented as a flu-like illness, followed by inappropriate behaviour, drowsiness and focal neurologic signs. Investigations indicated a lesion in the right temporal lobe. The diagnosis was confirmed by isolation of the virus from a cerebral biopsy. Pronounced clinical improvement was noted when cytosine arabinoside therapy was started in the postoperative period. This report supports the observation by some authors that cytosine arabinoside may be of value in the treatment of herpes simplex encephalitis.     

脑电图在病毒性脑炎中的诊断价值分析

目的:探讨分析脑电图在病毒性脑炎中的诊断价值。方法:详细记录87例临床确诊为病毒性脑炎患者的脑电图,并对其诊断价值进行深入的分析研究。结果:87例病毒性脑炎患者中,共发现69例异常状况(79.3%),其中轻度异常41例(47.1%),中度异常18例(20.7%),重度异常10例(11.5%)。结论:脑电图检查在病毒性脑炎的早期诊断、以及诊断治疗、预后判断等方面,都具有重要的参考作用。     

Herpes simplex encephalitis in infants

Two cases are reported of severe encephalitis in infants that were caused by a primary infection with herpes simplex virus type 1. Both patients presented with focal seizures; the clinical diagnosis was confirmed by the rapid appearance of IgM antibody to herpes simplex virus type 1 in cerebrospinal fluid and serum. In spite of the early use of acyclovir, which was administered by the intravenous route, the clinical response was poor and both infants were left with severe neurological impairment.     

Relapse of herpes simplex encephalitis after conventional acyclovir therapy

Acyclovir sodium is the drug of choice for the treatment of herpes simplex encephalitis. We treated an immunocompetent patient with a ten-day course of intravenous acyclovir sodium at the recommended dosage of 10 mg/kg every eight hours for clinically apparent herpes simplex encephalitis. After marked improvement, his condition deteriorated four days after completing acyclovir therapy. A subsequent brain biopsy specimen disclosed acyclovir-sensitive herpes simplex virus type 1. A longer duration of acyclovir therapy (14 to 21 days) should be considered for treating herpes simplex encephalitis.     

复发性病毒性脑炎的临床特点和发病机制探讨

目的 探讨复发性病毒性脑炎的诊断和复发机制.方法 回顾分析150例病毒性脑炎患者,其中5例为复发性病毒性脑炎,还有1例来自尸检病例.其中5例临床高度怀疑为单纯疱疹性脑炎,并且其中2例得到病理结果的证实.结果 6例患者在症状缓解后1个月至2年2个月,再次出现神经系统损害的表现,症状加重.并且6例患者中5例复发时,MRI或CT出现以额、颞灰质损害为主的新病灶;除1例患者死亡,其余5例患者承新给予阿昔洛韦抗病毒治疗后,病情均明显好转;例3脑组织HSV免疫组化染色阳性,例6尸检脑组织内可见细胞内包涵体,HSV免疫组化阳性,提供了病毒感染的直接病理依据.结论 这6例复发性病毒性脑炎复发的机制与病毒活化直接侵犯中枢神经系统有关.复发的原因仍不是十分清楚,可能与阿昔洛韦剂量不足或治疗不够充分有关.阿昔洛韦抗病毒治疗应遵循早期、足最、个体化的治疗原则,将有助于改善预后.     

小儿手足口病并发脑炎患儿的脑电图改变及其意义

目的探讨脑电图(EEG)在小儿手足口病并发脑炎患者中的应用及意义。方法回顾性分析325例临床确诊手足口病并发脑炎患儿的EEG资料,并与脑脊液的检查结果进行比较。结果 325例患儿中EEG异常301例(92.6%),EEG异常呈弥漫性慢波,部分出现棘(尖)波或棘(尖)慢波;脑脊液异常率为43.7%。结论脑电图可作为小儿手足口病并发脑炎的诊断及判断严重程度的一个指标,且脑电图较脑脊液检查更为敏感,对手足口病早期诊断有意义。     

单纯疱疹病毒感染后自身免疫性脑炎的研究进展

单纯疱疹病毒脑炎所引发的自身免疫性脑炎日益受到关注,其发病机制可能与单纯疱疹病毒感染神经元后神经元裂解释放抗原引起免疫反应有关。这种继发性的自身免疫性脑炎临床表现多样,早期容易与复发性单纯疱疹病毒性脑炎相混淆,延误治疗导致严重的神经功能缺损及预后不良。脑脊液和血清中检出自身免疫性脑炎相关抗体则有助于诊断,免疫治疗有效。本文结合相关文献综述了单纯疱疹病毒感染后的自身免疫性脑炎的发展历史、发病机制、临床表现、辅助检查和诊疗流程,为临床医生提供借鉴。     

Diagnosis and treatment of viral encephalitis

Acute encephalitis constitutes a medical emergency. In most cases, the presence of focal neurological signs and focal seizures will distinguish encephalitis from encephalopathy. Acute disseminated encephalomyelitis is a non-infective inflammatory encephalitis that may require to be treated with steroids. Acute infective encephalitis is usually viral. Herpes simplex encephalitis (HSE) is the commonest sporadic acute viral encephalitis in the Western world. Magnetic resonance imaging of brain is the investigation of choice in HSE and the diagnosis may be confirmed by the polymerase chain reaction test for the virus in the cerebrospinal fluid. In this article, we review the diagnosis, investigations, and management of acute encephalitis. With few exceptions (for example, aciclovir for HSE), no specific therapy is available for most forms of viral encephalitis. Mortality and morbidity may be high and long term sequelae are known among survivors. The emergence of unusual forms of zoonotic encephalitis has posed an important public health problem. Vaccination and vector control measures are useful preventive strategies in certain arboviral and zoonotic encephalitis. However, we need better antiviral therapy to meet the challenge of acute viral encephalitis more effectively.     

抗γ-氨基丁酸B受体脑炎患者12例临床特征分析

目的　探讨抗γ-氨基丁酸B（GABAB）受体脑炎的临床特征、实验室检查、影像学及脑电图表现、治疗和随访情况,提高对该病的认识。方法　回顾性分析2012年12月—2017年6月浙江大学医学院附属第二医院神经内科和宁波市医疗中心李惠利医院神经内科收治的12例诊断为抗GABAB受体脑炎患者的临床资料。收集患者临床特征、实验室检查、影像学及脑电图表现,通过改良Rankin量表（mRS）评估治疗效果及预后。结果　12例患者中男10例,中位发病年龄为56岁（范围为47~71岁）。癫痫发作（9/12）是最常见的首发表现,患者病程中均出现典型的癫痫发作症状。5例患者合并小细胞肺癌（SCLC）,1例存在胸腺瘤,2例怀疑肿瘤。患者均接受一线免疫治疗,仅2例接受肿瘤治疗。未发现肿瘤及已对肿瘤行针对性治疗的患者预后相对较好,确诊或怀疑肿瘤而未行肿瘤治疗患者预后较差。结论　抗GABAB受体脑炎是一种罕见的特殊类型自身免疫性疾病,多伴发肿瘤。中老年男性,以癫痫发作、精神行为异常、认知功能障碍等边缘性脑炎症状为突出表现时,需考虑到本病可能。早期识别这一潜在可治性疾病能改善患者预后。     

Dengue encephalitis–A rare manifestation of dengue fever

The clinical spectrum of dengue fever ranges from asymptomatic infection to dengue shock syndrome. Dengue is classically considered a non-neurotropic virus. Neurological complications are not commonly seen in dengue. The neurological manifestations seen in dengue are encephalitis, meningitis, encephalopathy, stroke and Guillain-Barré syndrome. Dengue encephalitis is a rare disease. We report an interesting case of dengue encephalitis from Southern India. A 49-year-old gentleman presented with fever, altered sensorium and seizures. Dengue NS-1 antigen test was reactive. Dengue IgM was also positive. CSF PCR was negative for herpes simplex 1 & 2. Dengue encephalitis should be considered in the differential diagnosis of fever with altered sensorium, especially in countries like India where dengue is rampant.     

脑脊液肠道病毒RT-PCR检测对病毒性脑炎患者的临床意义

的了解脑脊液肠道病毒（EV）逆转录-聚合酶链式反应（RT—PCR）检测对病毒性脑炎患者的临床诊断和治疗意义。方法回顾分析2000～2003年进行了脑脊液EVRT—PCR检测的43例患者的临床特征，包括临床症状、体征、脑脊液生化常规及其他病毒病原体检查、头颅影像学和脑电图检查，并进行统计学分析。结果脑脊液EVRT—PCR阳性者18例，占41．9％，男性较多，多发病于7～9月。脑脊液EVRT-PCR阳性者的临床症状与阴性者无明显差异，但脑脊液蛋白和细胞数较高，可同时合并血中其他病毒（单纯疱疹病毒、巨细胞病毒）抗体阳性。结论肠道病毒引起的病毒性脑炎发病率高，并可合并其他病毒感染，EVRT-PCR检查结果可指导临床诊断和针对性用药。     

更昔洛韦伍用复方甘草酸苷对带状疱疹的疗效分析

目的了解更昔洛韦伍用复方甘草酸苷对带状疱疹病人的疗效。方法将70例带状疱疹病毒病人分成2组,各35例,实验组使用上述药物,对照组给予阿昔洛韦治疗。结果用药15d后观察,2组临床症状体征改善及疗效比较,前者优于后者,且具统计学意义（P〈0.05）。结论更昔洛韦伍用复方甘草酸苷治带状疱疹之疗效,优于阿昔洛韦。     

Antiviral Effect of Chinonin against Herpes Simplex Virus

In order to investigate the antiviral effect of chinonin against Herpes simplex virus (HSV), the encephalitis model in mice and skin infection model in guinea pigs were established by HSV-Ⅰ and HSV-Ⅱ infection respectively. Acyclovir was used as the positive reference drug to evaluate the antiviral capacity of chinonin. Chinonin showed an obvious therapeutic effect on encephalitis in mice at doses of 25 and 50 mg/kg. At both dosages, chinonin demonstrated stronger protection than acyclovir (1 and 5 mg/kg) to the infected mice from death. It was also found that chinonin could treat the skin infection in guinea pigs effectively. The therapeutic effect of chinonin was similar to that of acyclovir (5 mg/kg) at 25 mg/kg but obviously better than that at 50 and 75 mg/kg. In conclusion, chinonin is a potential candidate for the treatment against HSV.     

Radiculomyelopathy associated with herpes simplex genitalis treated with adenosine arabinoside.

A case of herpes simplex genitalis producing radiculomyelopathy with urinary retention is reported. The patient was treated with adenosine arabinoside intravenously and made a complete recovery over 4 weeks. Although herpes simplex genitalis is common, neurological sequelae, particularly cord involvement, are distinctly rare. It should, nevertheless, be considered in the differential diagnosis of urinary retention, with or without long-tract signs, in young patients.     

Oral acyclovir for treatment of first-episode herpes simplex virus proctitis

Twenty-nine patients with first-episode rectal herpes simplex virus infection were enrolled in a double-blind trial of oral acyclovir, 400 mg five times daily, vs placebo treatment. Eighty percent of those receiving acyclovir compared with 25% of placebo recipients no longer had herpes simplex virus isolated from their rectal lesions three days after onset of therapy. The median duration of rectal lesions and viral excretion from rectal lesions (median, five and zero days, respectively) was significantly shorter in patients treated with acyclovir than in placebo-treated patients (14 and 11 days, respectively). Durations of local signs and symptoms of proctitis, such as rectal pain, discharge, and friability, were shorter in acyclovir recipients than in placebo recipients, but these differences were not statistically significant. Daily administration of 2 g of oral acyclovir for ten days alleviates some of the clinical signs of herpes simplex virus rectal infection.     

Fulminant hepatic failure for herpes simplex virus

Although exceedingly rare, fulminant hepatic failure in immunocompetent patients can develop with primary or recurrent infection due to herpes simplex virus. The diagnosis is frequently obscured by the absence of mucocutaneous involvement. Elevated transaminases with leucopenia and a relatively low bilirubin level may provide clues to the diagnosis. Here a female patient, 43 years, presented with the complaints of increasing jaundice, anorexia, nausea, vomiting for one week duration. She had hepatomegaly. Investigations revealed markedly raised transaminases and coagulopathy. Herpes simplex virus IGM (by ELISA) was positive. The immunocompetent woman was treated with acyclovir but the result was fatal.     

新生儿脑梗死临床分析

目的分析新生儿脑梗死的临床特征及影像学表现，做出早期诊断和治疗，以期改善本病的远期预后。方法总结10例确诊病例的临床特征及影像学表现，进行围产期因素和其它可能病因分析，并对部分存活患儿进行随访。结果10例新生儿脑梗死中6例（60％）出现各种形式惊厥，8例（80％）在早期均无定位体征，仅2例（20％）患儿表现为一侧活动减少。颅脑CT平扫或MRI均有阳性发现。随访3例患儿，2例均有明显落后，1例至6个月未发现异常。结论新生儿脑梗死并不少见，与窒息密切相关，常见临床表现为惊厥，影像检查是本病主要确诊方法，早期诊断及治疗对预后至关重要。     

Antiviral effect of chinonin against herpes simples virus

Summary In order to investigate the antiviral effect of chinonin against Herpes simplex virus (HSV), the encephalitis model in mice and skin infection model in guinea pigs were established by HSV-1 and HSV-II infection respectively. Acyclovir was used as the positive reference drug to evaluate the antiviral capacity of chinonin. Chinonin showed an obvious therapeutic effect on encephalitis in mice at doses of 25 and 50 mg/kg. At both dosages, chinonin demonstrated stronger protection than acyclovir (1 and 5 mg/kg) to the infected mice from death. It was also found that chinonin could treat the skin infection in guinea pigs effectively. The therapeutic effect of chinonin was similar to that of acyclovir (5 mg/kg) at 25 mg/kg but obviously better than that at 50 and 75 mg/kg. In conclusion, chinonin is a potential candidate for the treatment against HSV. JIANG Jie, male, born in 1973. M.D., Ph.D.     

肾移植术后带状疱疹的诊断与治疗

目的：探讨肾移植术后并发带状疱疹的诊治方法。方法：回顾性分析23例肾移植术后并发水痘-带状疱疹病毒（VZV）感染患者的临床资料。结果：肾移植患者并发VZV感染多发生在术后1～2年,根据患者临床表现及体征即可可诊断带状疱疹,23例患者在发生VZV感染后均根据血环孢素A（CsA）浓度谷值和峰值适当减少CsA用量,或调整免疫抑制剂联合用药方案。15例采用阿昔洛韦1200mg／d口服10～14天,治疗有效;另8例阿昔洛韦治疗效果不明显,改用更昔洛韦,剂量为500mg／d静脉滴注7～14天,治疗有效。所有患者在抗VZV感染的同时均使用抗生素,以防止合并细菌感染,并给予止痛、神经封闭等综合治疗。本组治疗总有效率为100％（23／23）。结论：肾移植术后VZV感染多发,诊断并不困难,治疗上合理用药非常重要,并相应调整免疫抑制治疗方案,阿昔洛韦和更昔洛韦对VZV感染有较好的疗效。