Kohira I, Shohmori T, Kuroda S, Kanzaki A, Higashi H, Higashi Y, Higashi S, Handa A, Kinoshita K, Terasaka K
Department of Neurology, Okayama University Medical School, Japan.
No To Shinkei. 1992 Jul;44(7):649-53.
We report a patient with encephalitis who showed anterograde and retrograde amnesia with MRI abnormalities localized in the bilateral amygdala (AM) and hippocampus (HIPP). A 25-year-old man suddenly experienced a generalized tonic-clonic seizure (GTCS). He was admitted because of increasing lethargy with two further GTCSs during the following 6 days. The patient had high fever, and neurological examination revealed somnolence, disorientation, amnesia, and nuchal stiffness. MRI revealed bilateral symmetrical abnormalities localized in the AM and HIPP, which showed low intensity on T1-weighted images and high intensity on T2-weighted images. Cerebrospinal fluid examination showed a mildly elevated cell count. We suspected herpes simplex virus type I encephalitis and began treatment with acyclovir. After the patient regained a clear consciousness, his antero- and retrograde amnesia continued for several months. The MRI abnormality became less distinct with the improvement of amnesia. We consider that the MRI abnormality was indicative of inflammation and edema, and that the lesion in the AM and HIPP had induced the amnesia.
我们报告了一名患有脑炎的患者，该患者表现出顺行性和逆行性失忆，磁共振成像（MRI）异常定位于双侧杏仁核（AM）和海马体（HIPP）。一名25岁男性突然出现全身强直阵挛性发作（GTCS）。在接下来的6天里，他因嗜睡加重并又出现两次GTCS而入院。患者高热，神经系统检查显示嗜睡、定向障碍、失忆和颈部强直。MRI显示双侧对称异常定位于AM和HIPP，在T1加权图像上呈低信号，在T2加权图像上呈高信号。脑脊液检查显示细胞计数轻度升高。我们怀疑为I型单纯疱疹病毒性脑炎，并开始用阿昔洛韦治疗。患者意识恢复清醒后，其顺行性和逆行性失忆持续了数月。随着失忆症状的改善，MRI异常变得不那么明显。我们认为MRI异常表明存在炎症和水肿，并且AM和HIPP中的病变诱发了失忆。
