单纯疱疹病毒脑炎的非典型临床表现  

Atypical clinical manifestations of herpes simplex encephalitis

作　　者：李伟荣[1] 冯子敬[1] 王佳伟[1] 王得新[1] 

机构地区：[1]首都医科大学附属北京友谊医院神经内科,北京100050

出　　处：《中国现代神经疾病杂志》2005年第2期97-100,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的对临床表现和实验室检查结果不具典型特征的单纯疱疹病毒脑炎患者进行回顾性总结,以提高对本病的诊断水平。方法对142例单纯疱疹病毒脑炎患者的病史、临床表现、脑脊液细胞学检查、脑脊液及血清病毒学、脑电图及神经影像学资料进行分析。结果142例中38例(26.76%)为非急性起病,受损部位除常见的额、颞叶外,还可侵及脑干。50例(35.21%)脑脊液细胞学检查以中性粒细胞升高为主,而非淋巴细胞占优势。69例行脑脊液特异性1型单纯疱疹病毒IgM抗体检测,阳性者12例(17.39%),余57例(82.61%)均呈阴性。17例行双份血清和脑脊液标本特异性IgG抗体检测,其中恢复期标本1型单纯疱疹病毒IgG抗体水平增高4倍以上者5例,无明显变化者9例,恢复期抗体水平降低4倍者3例。68例中65例(95.59%)脑电图未见典型的局灶性尖、棘波。52例患者接受影像学检查(M RI检查10例,CT检查42例),其中28例未见典型影像学改变,分别占受检者的30.00%(3/10)和59.52%(25/42)。结论单纯疱疹病毒脑炎的起病、临床表现和实验室检查可呈不典型表现,明确诊断有赖于对各项资料进行综合分析。对于亚急性或慢性起病患者,建议检测双份血清和脑脊液标本中的特异性1型单纯疱疹病毒IgG抗体,以对病毒抗体水平进行连续和动态观察。Objective To retrospectively summerize the data of herpes simplex encephalitis (HSE) patients with atypical clinical manifestations and laboratory examination results for improving the diagnostic level of this disease. Methods The history, clinical manifestations, data of cytological examination of cerebrospinal fluid (CSF), virological examination of CSF and serum, EEG and neuroimaging were analyzed. Results Of the 142 patients, 38 cases (26.76%) were not acute onset, their lesions might invole the brain stem except the common occurrence in frontal and temporal lobe. Cytological examination of CSF mainly showed increasing of neutrophil but not lymphocyte in 50 cases (35.21%). There were 57 (82.61%) negative and 12 (17.39%) positive in 69 patients with examination of CSF specific IgM antibody for herpes simplex virus type 1(HSV-1). Both examination of CSF and serum in 17 patients demonstrated that the specific IgG level increase to 4 times in 5 cases, without significant change in 9 cases and 3 cases decreased below 1/4 in recovery period. The typical focal spike or sharp wave in EEG were not occurred in 65 cases (95.59%) of 68 patients. The imaging examination in 52 patients, MRI 10 and CT 42, showed no typical characteristics in 28 cases. The negative rates were 30.00% (3/10) and 59.52% (25/42) in MRI and CT imaging respectively. Conclusion The onset clinical manifestation and laboratory tests may present atypical characteristics in HSE patients. The definite diagnosis is depending on the comprehensive analysis of various data. It is suggested that the HSV-1 IgG level in both CSF and serum should be detected in subacute or chronic HSE patients for continuous and dynamic surveying of the IgG level change.

关 键 词：单纯疱疹病毒脑炎 非典型临床表现 1型单纯疱疹病毒 脑脊液细胞学检查 中性粒细胞升高 IgM抗体检测 IgG抗体检测 IGG抗体水平 脑脊液标本 血清病毒学 影像学资料 非淋巴细胞 MRI检查 影像学检查 影像学改变 不典型表现 

分 类 号：R742.9[医药卫生—神经病学与精神病学]