Piekarska Anna
Katedry i Kliniki Chorób Zakaźnych Akademii Medycznej w Łodzi.
Neurol Neurochir Pol. 2003 Mar-Apr;37(2):409-17.
Herpes simplex encephalitis (HSE) is a rare infection of the central nervous system. The prognosis is poor, even in those receiving anti-herpetic therapy (about 20% of patients die, and in 40% of cases neurological sequelae are severe). The diagnosis is based on clinical signs of encephalitis, typical pathological changes in MRI, and on the presence of anti-HSV antibody and/or HSV-DNA in the cerebrospinal fluid. Three cases of encephalitis are presented. The clinical course and pathological changes in the temporal lobes seen in MRI were characteristic of the HSV etiology. Early intrathecal synthesis of anty-HSV antibodies were not detected despite an increase in their serum level in the course of the disease. HSV-DNA detection with PCR was not performed. Nevertheless in all cases aciclovir therapy was introduced on the first day of hospitalization. Possibilities of diagnosing HSE on the basis of clinical signs and MRI scans during the first week of the disease are discussed, as well as the tissue whether the course of treatment would be changed accordingly to the PCR test results.
单纯疱疹性脑炎（HSE）是一种罕见的中枢神经系统感染。其预后较差，即使是接受抗疱疹治疗的患者也是如此（约20%的患者死亡，40%的病例会出现严重的神经后遗症）。诊断基于脑炎的临床体征、MRI的典型病理变化以及脑脊液中抗HSV抗体和/或HSV-DNA的存在情况。本文介绍了3例脑炎病例。MRI显示的临床病程及颞叶的病理变化具有HSV病因的特征。尽管在疾病过程中血清中抗HSV抗体水平升高，但未检测到早期鞘内抗HSV抗体合成。未进行PCR检测HSV-DNA。然而，所有病例均在住院第一天就开始使用阿昔洛韦治疗。本文讨论了在疾病第一周根据临床体征和MRI扫描诊断HSE的可能性，以及是否会根据PCR检测结果相应改变治疗方案。
