伴Kluver-Bucy综合征的单纯疱疹病毒性脑炎2例临床特征

Clinical features of 2 Herpes Simplex Encephalitis with human Kluver-Bucy syndrom

目的探讨单纯疱疹病毒性脑炎的临床表现及K luver-Bucy综合征的特点。方法对2例(女1例,男1例)临床诊断的单纯疱疹病毒性脑炎患者资料进行回顾性分析。结果(1)2例患者均有发热、精神行为异常、多食、饮食习惯改变。例1还伴有口部探索(咬人)和吃一些非食物的东西。例2伴有视觉失认、温顺、性活动增强、癫痫。(2)头颅M R I均有双侧颞叶损害。(3)脑脊液细胞数轻度增高(单核细胞为主),蛋白质增高。(4)脑电图:弥漫性异常,额颞著。(5)早期经无环鸟苷治疗,病情逐渐好转。结论伴KBS的单纯疱疹性脑炎的临床特点有:高热,行为异常,视觉失认,平静温顺,贪食,饮食习惯改变,性活动增强和口部探索。诊断以临床表现,实验室和影像学检查为依据。KBS和双侧颞叶损害有关。早期无环鸟苷治疗可改善预后,镇静药或卡马西平治疗可改善KBS症状。

Objective To investigate the clinical findings of herpes simplex encephalitis（HSE）and features of human Kluver-Bucy syndrom（KBS）. Methods A retrospective analysis of 2 cases of HSE was focused on their clinical manifestations. Results The clinical features of HSE showed：（1）High fever,behavioural abnormality,increased appetite in 2 cases,excessive oral tendency and eating of inedible objects in 1 case ,psychic blindness （or visual agnosial） and placidity（with loss of normal fear and anger）,aberrant sexual behaviour,seizures in another case. （2）Head MRI showed ：lesions of the bilateral temporal. （3）Cerebrospinal fluid（CSF） showed：cells increased slightly（with monocytic cell mainly） and CSF protein content was increased. （4）EEG showed：diffuse abnormality （fronto-temporal is marked）. （5）Early acyclovir therapy can prevent its mortality and limit morbidity. Conclusion The Main clinical features of HSE with KBS are high fever,behavoural abnormality,psychic blindness ,placidity, increased appetite,changes in dietary habits ,hypersexuality and hyperorality. The diagnosis relies on clinical manifestations,examinations of laboratory and neuroimaging. Anatomic lesions in KBS involve the bilateral temporal lobe. Acyclovir can improve prognosis. Neuroleptics or carbamazepine therapy is most effective for KBS.