急性Ⅰ型单纯疱疹病毒感染性脑炎影像学表现

Imaging manifestations of acute viral encephalitis caused by typeⅠ herpes simplex virus

目的探讨急性Ⅰ型单纯疱疹病毒性脑炎(Herpes Simplex Virus Encephalitis,HSE)不同病理机制多种影像学表现,以提高治愈率。方法回顾性分析2003-2013年16例确诊HSE有脑出血病灶的患者临床资料,对其进行影像学检查,16例HSE患者均先行CT检查,根据病情其中有7例患者行MRI检查,对影像学的多种重要表现结合文献进行分析总结。结果 HSE患者发病早期30min^2h在CT影像上基底节密度稍增高,基底节突出显示,即"基底节突显征";发生于基底节、脑灰质及灰白质交界区的细微小灶状、小疱疹样出血,具有一定的典型意义;发生于颞叶脑白质病变多呈水肿、变性样改变,CT上低密度、MRI上呈长T1长T2信号,多发生于颞叶而基底节未受累呈现"刀切征",则是公认的较为典型征像。结论影像诊断多种检查技术联合应用,总结出单纯疱疹病毒(HSV)感染所致HSE的影像的一些特征性表现,对HSE患者影像诊断、特别是早期诊断具有重要意义,对降低HSE患者的病死率及致残率有一定价值。

OBJECTIVE To explore the various manifestations of imaging of acute type I herpes simplex encephalitis （HSE） under different pathological mechanisms so as to improve the cure rate. METHODS The retrospective anal- ysis was conducted of clinical data of 16 patients diagnosed to have lesions of cerebral hemorrhage due to HSE dur- ing 2003--2013. The patients received imaging examination. All the 16 HSE patients were first examined by CT, then 7 of them were examined by MRI according to disease condition. The various important manifestations were summarized and analyzed in combination with literature researches. RESULTS In the eariy period of onset （30 min - 2 h of onset）, CT imaging showed slightly increased density of basal ganglia and highlighted signs of basal gan- glia, i. e. , prominent sign of basal ganglia. Tiny lesions and small hemorrhage herpetiformis, which might be typ- ical, occurred in basal ganglia, gray matter and the junction area of gray matter and wl^ite matter. Leukodystrophy in temporal lobe was manifested as edema and degenerationqike changes presented as iow density by CT and long T1 and long T2 signal by MRI, i. e. , the knife sign, which mainly occurred in temporal lobe, but basal ganglia was not involved. It was recognized as a typical sign. CONCLUSION By imaging diagnosis combined with a variety of test techniques, some characteristic images of HSE manifestations caused by herpes simplex virus （HSV） infec- tion were summarized, which is important for imaging diagnosis of HSE, especially for the early diagnosis and has certain significance for reducing the mortality and the disability of HSE patients.