成人病毒性脑炎126例临床分析

目的　探讨成人病毒性脑炎的临床特征、诊断、治疗和影响预后的因素。方法　对 12 6例成人病毒性脑炎患者的临床表现、脑脊液、脑电图和影像学检查、治疗效果进行综合性分析。结果　发热 112例 (88.89% ) ,头痛76例 (6 0 .32 % ) ,意识障碍 75例 (5 9.5 2 % ) ,其中昏迷 34例 ,嗜睡 2 6例 ,昏睡 15例 ,精神行为异常 71例 (5 6 .35 % ) ,呕吐 6 9例 (5 4 .76 % ) ,颈强 6 5例 (5 1.5 9% ) ,癫痫发作 5 0例 (39.6 8% ) ,肢体瘫痪 4 1例 (32 .5 4 % ) ,合并颅神经麻痹2 8例 (2 2 .2 2 % )。合并锥体外系症状 2 2例 (17.4 6 % )。共济失调 18例 (14 .2 9% )。CSF异常率 94 .87% (111 117) ,其中颅内压增高者 110例 ,细胞数增多者 10 6例 ,蛋白增高者 10 5例。EEG检查异常率 88.33% (10 6 12 0 )。头颅CT检查异常率 5 5 .0 0 % (4 4 80 )。脑的MRI检查异常率 10 0 % (2 6 2 6 )。影像学上见到颅内出血 11例。出院时完全康复 5 2例 (4 1.2 7% ) ,死亡 5例 (3.97% ) ,其余均遗留有不同程度的神经功能缺损。结论　成人病毒性脑炎早期以意识障碍和精神行为异常为主要特征。CSF、EEG、MRI是重要的辅助诊断手段。患者年龄 ,起始治疗的时间 ,意识障碍及精神行为异常的程度 ,以及脑内病变的程度是影响预后的重要因

Clinical studies in 126 cases of viral encephalitis in adults

Objective To discuss the clinical characteristics, diagnosis, therapy, and the factors influenced on prognosis of viral encephalitis in adults.Methods We comprehensively analyze the clinical presentation of 126 patients with viral encephalitis, and its findings of cerebrospinal fluid (CSF), eletroencephalography (EEG), and imaging examinations.Results 112 of 126 patients had fever (88.89%), 76 (60.32%) had headache, 75 (59.52%) had the altered consciousness (34 coma, 26 somnolence, 15 stupor); mental abnormalities were seen in 71 cases (56.35%), vomiting in 69 (54.76%), nuchal rigidity in 65 (51.59%), seizure in 50 (39.68%), hemiparesis in 41 (32.54%), cranial nerve palsy in 28 (22.22%), extrapyramidal disorders in 22 (17.46%), ataxia in 18 (14.29%). CSF specimens were examined in 117 cases, and revealed abnormal in 111 (94.87%). Among them, 110 cases had an elevated opening pressure, 106 pleocytosis, and 105 slightly elevated protein level. EEG were examined in 120 cases, and revealed abnormal in 106 (88.33%). Computer tomography (CT) were examined in 80 cases, and revealed abnormal in 34 (42.50%). Intracranial hemorrhage were seen in 11 cases. All of 26 cases (100%) examined by magnetic resonance imaging (MRI) revealed abnormalities. When they were discharged, 52 of 126 cases (41.27%) recovered completely, but others left more or less neurological deficits. 5 cases (3.97%) were died.Conclusions Viral encephalitis in adults is characterized by the early alteration of consciousness and mental abnormalities. CSF, EEG and MRI are very helpful to diagnosis of viral encephalitis. The age of patients, the duration of illness prior to the therapy, the extent of altered consciousness and mental abnormalities, and the lesion of the brain showed to be the important factors on the prognosis.