病毒性脑炎临床症状与视频脑电图及功能磁共振检测分析

Analysis of Clinical Symptoms and Video EEG and Functional Magnetic Resonance Imaging of Viral Encephalitis

目的:探讨病毒性脑炎临床症状及视频脑电图(VEEG)、功能磁共振(FMC)的诊断价值。方法:选取2016年1月-2017年4月本院收治的病毒性脑炎患者86例为研究对象,均经VEEG、FMC检查,分析病毒性脑炎的临床症状及VEEG、FMC检查结果。结果:患者主要临床表现发热40例(46.5%)、头痛27例(31.4%)、呕吐22例(25.6%)、烦躁不安13例(15.1%)、嗜睡8例(9.3%)、伴有肌力下降7例(8.1%)、昏迷5例(5.8%),合并出血4例(4.7%)、构音障碍2例(2.3%),脑膜刺激征阳性者47例(54.7%),以癫痫为首发症状者9例(10.5%);δ、θ、α、β功率比值分别为(13.96±0.83)、(22.41±2.93)、(26.13±3.92)、(11.46±1.05),且癫痫首发症状者VEEG异常程度显著高于非癫痫首发症状者(P<0.001);FMC检查病灶部位集中在额叶、颞叶、顶叶、海马、岛叶及基底节-丘脑区,单侧病灶稍多于双侧病灶;VEEG诊断病毒性脑炎的阳性率为95.4%,显著高于FMC的82.6%,比较差异有统计学意义(P<0.05)。结论:病毒性脑炎临床症状可表现为发热、头痛、呕吐、脑膜刺激征、烦躁不安、嗜睡、昏迷、肌力下降、构音障碍等,部分以癫痫为首发症状,病灶部位集中在额叶、颞叶、顶叶、海马、岛叶及基底节-丘脑区,且病灶多呈现对称性;VEEG对病毒性脑炎的诊断优于FMC,且在评估以癫痫为首发症状的病毒性脑炎病情程度价值较高。

Objective:To investigate the clinical symptoms of viral encephalitis and the diagnostic value of video EEG(VEEG)and functional magnetic resonance imaging(FMC).Method:A total of 86 patients with viral encephalitis from January 2016 to April 2017 in our hospital were selected as the research objects.All of them were examined by VEEG and FMC.The clinical symptoms and the results of VEEG and FMC were analyzed.Result:The main clinical manifestations were fever in 40 cases(46.5%),headache in 27 cases(31.4%),vomiting in 22 cases(25.6%),restlessness in 13 cases(15.1%),drowsiness in 8 cases(9.3%),myodynamia in 7 cases(8.1%)and coma in 5 cases(5.8%),combined hemorrhage was found in 4 cases(4.7%)and dysarthria in 2 cases(2.3%),meningeal irritation sign was positive in 47 cases(54.7%),epilepsy was the first symptom in 9 cases(10.5%).The power ratios ofδ,θ,α,βwere(13.96±0.83),(22.41±2.93),(26.13±3.92),(11.46±1.05)respectively,the degree of abnormal VEEG in patients with first symptom was significantly higher than that of non epileptic first symptom(P<0.001).The lesions in FMC were concentrated in frontal lobe,temporal lobe,parietal lobe,hippocampus,insular lobe and basal ganglia-thalamus region,and the lesions on one side were slightly more than those on both sides.The positive rate of VEEG in diagnosing viral encephalitis was 95.4%,which was significantly higher than 82.6%of FMC,the difference was statistically significant(P<0.05).Conclusion:The clinical symptoms of viral encephalitis may be fever,headache,vomiting,meningeal irritation,restlessness,drowsiness,coma,decreased muscle strength,and dysarthria,epilepsy is the first symptom in some cases,the focus are concentrated in frontal lobe,temporal lobe,parietal lobe,hippocampus,insular lobe and basal ganglia-thalamus region,and lesions showed symmetry.VEEG is superior to FMC in diagnosis of viral encephalitis,and has higher value in evaluating the severity of viral encephalitis with epilepsy as its first symptom.