Yoshidome Yoshito, Hayashi Shigeaki, Maruyama Yoshikazu
Department of Neurology, Imakiire General Hospital.
Rinsho Shinkeigaku. 2005 Apr;45(4):293-7.
A 24-year-old man was admitted to our hospital because of consciousness disturbance, a stiff neck and various brainstem symptoms including a right one-and-a-half syndrome and right peripheral facial palsy a week after an episode of pharyngitis and right facial herpes simplex. Magnetic resonance imaging of the brain on admission showed high-signal intensities in the right pontine tegmentum, right cerebellar peduncle and vermis on fluid-attenuated inversion recovery imaging. Examination of cerebrospinal fluid yielded mononuclear pleocytosis, elevated protein and increased IgM antibodies to herpes simplex virus (HSV) by enzyme immunoassay. HSV-1 specific antibodies also were detected in serum by neutralization test. We gave a diagnosis of brainstem encephalitis caused by HSV-1. The patient was successfully treated with high dose of acyclovir, steroid and intravenous immunoglobulin. He was discharged without any neurologic sequelae. We herein presented a case of atypical encephalitis due to HSV-1 involving mainly the brainstem with possible infection via right trigeminal nerve and summarized recent 35 cases with herpetic brainstem encephalitis since 1990.
一名24岁男性因意识障碍、颈部僵硬以及多种脑干症状（包括右侧一个半综合征和右侧周围性面瘫）入院，这些症状出现在咽炎和右侧面部单纯疱疹发作一周后。入院时脑部磁共振成像显示，在液体衰减反转恢复成像上，右侧脑桥被盖、右侧小脑脚和蚓部呈高信号强度。脑脊液检查显示单核细胞增多、蛋白质升高，通过酶免疫测定法检测到单纯疱疹病毒（HSV）的IgM抗体增加。通过中和试验在血清中也检测到了HSV - 1特异性抗体。我们诊断为HSV - 1引起的脑干脑炎。患者接受了大剂量阿昔洛韦、类固醇和静脉注射免疫球蛋白治疗，治疗成功。他出院时没有任何神经后遗症。我们在此报告了一例由HSV - 1引起的非典型脑炎病例，主要累及脑干，可能通过右侧三叉神经感染，并总结了自1990年以来最近35例疱疹性脑干脑炎病例。
