疱疹病毒性脑炎并发视力下降二例

Two cases of viral encephalitis complicated by vision loss

目的探讨疱疹病毒性脑炎和视力下降的关系。方法对2例疱疹病毒性脑炎患者腰椎穿刺,行脑脊液测压、常规、生化、细胞学及病原学检查及头颅磁共振(MRI)检查;例1患者行眼科超声检查。结果2例患者均在入院治疗过程中出现视力下降。例1为单纯疱疹病毒感染,例2为巨细胞病毒感染。2例患者头颅MRI扫描均有脑实质炎性改变,均涉及岛叶。例1眼科超声提示视网膜坏死及视网膜脱离。结论疱疹病毒感染与急性视网膜坏死综合征及视神经炎有关。对于病毒性脑炎患者应给与足够的抗病毒治疗,期间若出现视力下降,警惕合并急性视网膜坏死综合征及视神经炎。

Objective To explore the relationship between viral encephalitis and vision loss and analyze the clinical manifestations, cerebrospinal fluid cytology, image and ultrasonography features of cases with viral encephalitis complicated by vision loss. Methods 2 cases were underwent lumber puncture. The pressure, routine observation, biochemical observation, aetiology and cytology of cerebrospinal fluid （CSF） were examined. The patients were performed MRI scan. Case 1 was given uhrasonography. Results Two cases complained of decreased vision after admission. Case 1 was infected with herpes simplex virus, while case 2 was cytomegalovirus （CMV） infection. Two cases of brain MRI revealed inflammatory changes in brain parenchymal, especially in insula. Uhrasonography revealed retinal necrosis and detachment of retina. Conclusion Herpesvirus infection is associated with acute retinal necrosis syndrome （ARNS） and neuritis optica. We have to continue antiviral treatment as long term against viral encephalitis. We shall be wary of ARN and neuritis optica when viral encephalitis is complicated by vision loss.