单纯疱疹病毒性脑炎20例临床诊治分析

The analysis of clinical diagnosis and therapy on herpes simplex virus encephalitis

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。

Objective To study the method of early clinical diagnosis and therapy on herpes simplex virus encephalitis（HSE）. Methods To review and analyse the clinical data in 20 cases with herpes simplex virus encephalitis. Results （ 1 ）The 20 cases were acute or subacute onset; （2）There were some previous clinical symptom, such as headache, fever, hypomnesia, emotional disturbance, epileptic attack with or not with conscious disturbance; （3）Skull MRI was more sensitive than skull CT. In earlier period, there was abnormal high signal in temporal lobe, frontal lobe, apical lobe, and insular lobe in MRI; （4）There was midrange abnormal brain wave in EEG, and mostly shovm up predominant wave in temple and frontal region,or periodic caltrop - slow wave; （ 5 ） We found the reaction of lymph - cell in cerebrospinal fluid （ CSF）, and some with considerable red cell： （6） Ganeiclovir and hyperbaric oxygen therapy was significant for HSE. Conclusion According to the earlier clinical manifestation, feature of imageology, EEG and examination of C. S. F, we can draw up to diagnose HSE, and early utilize Ganeielovir and hyperbaric oxygen therapy, so as to improve prognosis.