Background:Electroencephalogram(EEG)is an important tool for the diagnosis of herpes simplex virus encephalitis(HSE).However,the diagnosis of non-convulsive status epilepticus(NCSE)in HSE is challenging without the he...Background:Electroencephalogram(EEG)is an important tool for the diagnosis of herpes simplex virus encephalitis(HSE).However,the diagnosis of non-convulsive status epilepticus(NCSE)in HSE is challenging without the help of continuous video EEG(CVEEG),and whether EEG is a predictor of outcome remains controversial.Case presentation:A 63-year-old woman presented with a 5 day history of fever,coma and seizures.Results of EEG,magnetic resonance imaging and polymerase chain reaction(PCR)in cerebrospinal fluid(CSF)were suggestive of herpes simplex encephalitis-1(HSE-1).Preliminary EEG showed periodic discharges at the prefrontal and temporal lobes,which were particularly synchronized with intermittent lip smacking movements,and the discharges were terminated by diazepam.After 2-week treatment with acyclovir,high-dose hormone pulse therapy and high-dose immunoglobulin therapy,the CSF was improved,but the patient’s consciousness became worsen,consistent with the diffuse slow waves in the delta range and low voltage of EEG activity.In the following 1 month,the patient had non-responsiveness to pain and sound as shown by CVEEG with diffuse slow waves.Sometimes paroxysmal very slow waves(0.5–1 Hz)were synchronized with intermittent paroxysmal eye movements,pupil abnormality,and sweating in the frontal area.After 2 months of treatment,the EEG abnormalities improved to have alpha rhythm.Conclusion:The CVEEG not only helps identify NCSE but can also be used to monitor HSE progression.展开更多
基金the General Project of National Natural ScienceFoundation of China(Grant No.81901311).
文摘Background:Electroencephalogram(EEG)is an important tool for the diagnosis of herpes simplex virus encephalitis(HSE).However,the diagnosis of non-convulsive status epilepticus(NCSE)in HSE is challenging without the help of continuous video EEG(CVEEG),and whether EEG is a predictor of outcome remains controversial.Case presentation:A 63-year-old woman presented with a 5 day history of fever,coma and seizures.Results of EEG,magnetic resonance imaging and polymerase chain reaction(PCR)in cerebrospinal fluid(CSF)were suggestive of herpes simplex encephalitis-1(HSE-1).Preliminary EEG showed periodic discharges at the prefrontal and temporal lobes,which were particularly synchronized with intermittent lip smacking movements,and the discharges were terminated by diazepam.After 2-week treatment with acyclovir,high-dose hormone pulse therapy and high-dose immunoglobulin therapy,the CSF was improved,but the patient’s consciousness became worsen,consistent with the diffuse slow waves in the delta range and low voltage of EEG activity.In the following 1 month,the patient had non-responsiveness to pain and sound as shown by CVEEG with diffuse slow waves.Sometimes paroxysmal very slow waves(0.5–1 Hz)were synchronized with intermittent paroxysmal eye movements,pupil abnormality,and sweating in the frontal area.After 2 months of treatment,the EEG abnormalities improved to have alpha rhythm.Conclusion:The CVEEG not only helps identify NCSE but can also be used to monitor HSE progression.
