误诊为脑挫裂伤的单纯疱疹病毒性脑炎临床分析  

Clinical Analysis of Herpes Simplex Virus Encephalitis Misdiagnosed as Brain Contusion and Laceration

作　　者：林康越 吕华亮 LIN Kangyue;LYU Hualiang(The First Clinical Medical College,Guangdong Medical University,Zhanjiang,Guangdong 524023,China;Department of Neurocritical Care Medicine,People's Hospital of Maoming City,Maoming,Guangdong 525000,China;Department of Respiratory and Critical Care Medicine,People's Hospital of Maoming City,Maoming,Guangdong 525000,China)

机构地区：[1]广东医科大学第一临床医学院,广东湛江524023 [2]茂名市人民医院神经重症科,广东茂名525000 [3]茂名市人民医院呼吸与危重医学科,广东茂名525000

出　　处：《临床误诊误治》2024年第19期11-17,共7页Clinical Misdiagnosis & Mistherapy

基　　金：广东省茂名市科学技术研究与发展计划项目(2020124)。

摘　　要：目的探讨误诊为脑挫裂伤的单纯疱疹病毒性脑炎的临床特点、误诊原因及防范措施。方法回顾分析2019年9月至2021年8月2例误诊为脑挫裂伤的单纯疱疹病毒性脑炎患者的临床资料。结果1例青年男性,以头痛伴精神差3 d由外院转入。1例老年女性,有高血压病史,被发现呼之不应2 d,烦躁1 d由外院转入。2例颅脑影像学提示多发性脑挫裂伤,误诊为多发性脑挫裂伤,后经脑脊液病原微生物高通量基因检测确诊为单纯疱疹病毒1型脑炎。误诊时间分别为5 d和9 d。2例经抗病毒、免疫调节治疗后好转出院,随访6个月,格拉斯哥预后量表评分分别为3分和5分。结论单纯疱疹病毒性脑炎的临床表现无特异性,其影像学、脑脊液改变与早期的脑挫裂伤具有相似性,且单纯疱疹病毒性脑炎并发明显的脑出血相对罕见。当病史不详时,容易延误诊治。熟知该病的临床特点,并对此类患者反复追问病史,尽早完善病原学检查,能提高确诊率,减少或避免误诊误治。Objective To investigate the clinical features,causes of misdiagnosis and prevention measures of herpes simplex virus encephalitis(HSE)that was initially misdiagnosed as brain contusion and laceration.Methods The clinical data of 2 patients with HSE who were misdiagnosed as brain contusion and lacerations from September 2019 to August 2021 were retrospectively analyzed.Results A young male patient was transferred from another hospital with headache and mental disturbance for 3 d.An elderly woman with a history of hypertension was transferred from another hospital due to being unresponsive when called for 2 d and being restless for 1 d.Cerebral imaging of two patients showed multiple brain contusion,which was misdiagnosed as multiple brain contusion,and later confirmed as type 1 HSE by high-throughput genetic detection of pathogenic microorganisms in cerebrospinal fluid.The duration of misdiagnosis was 5 d and 9 d,respectively.Two patients were discharged from hospital after antiviral and immunomodulatory treatment.They were followed up for 6 months with Glasgow prognostic scale scores of 3 and 5,respectively.Conclusion The clinical manifestations of HSE are not specific,and the imaging and cerebrospinal fluid changes are similar to those of the early brain contusion and lacerations,and the cerebral hemorrhage complicated by HSE is relatively rare.When the medical history is unknown,it is more likely to delay diagnosis and treatment.Understanding the clinical characteristics of the disease,and repeatedly inquiring about the history of such patients,and performing the etiological examination as soon as possible,can improve the diagnosis rate,and reduce or avoid misdiagnosis and treatment.

关 键 词：脑炎 病毒性 单纯疱疹病毒 误诊 脑挫裂伤 脑出血 诊断 意识障碍 预后 

分 类 号：R512.3[医药卫生—内科学]