De Tiège Xavier, Rozenberg Flore, Burlot Karine, Gaudelus Joël, Ponsot Gérard, Héron Bénédicte
Department of Paediatric Neurology, Hôpital Cochin-Saint Vincent de Paul, Paris, France.
Dev Med Child Neurol. 2006 Jan;48(1):60-3. doi: 10.1017/S0012162206000120.
A 5-year-old female presented with prolonged afebrile right-sided focal seizures, right brachio-facial paralysis, and dysarthria; consciousness was not altered. Fever appeared 20 hours after onset of neurological symptoms. At admission (day 1) cerebral computerized tomography and cerebrospinal fluid (CSF) analyses were normal including undetectable alpha-interferon (alpha-IFN) and negative herpes simplex virus (HSV) polymerase chain reaction (PCR). Acyclovir was started at a dosage of 60mg/kg/day for 21 days and neurological symptoms improved. Cerebral magnetic resonance imaging (MRI) showed lesions in the left thalamus and left parietal lobe. On day 8, CSF contained an elevated leukocyte count with a predominance of lymphocytes, but alpha-IFN and HSV DNA were still undetectable. Delayed intrathecal synthesis of specific anti-HSV antibodies was found on day 26 and confirmed herpes simplex encephalitis (HSE) diagnosis. Twenty months after this episode, the patient presented with a febrile meningeal syndrome. PCR detected HSV DNA in CSF and cerebral imaging showed a new left temporal lesion. At relapse onset, intrathecal synthesis of specific anti-HSV antibodies had disappeared. Acyclovir was started at a dosage of 60mg/kg/day for 21 days and neurological status improved. At discharge, neurological examination showed right hemiparesis and bucco-facial dyspraxia. Diagnostic problems of HSE diagnosis in children are highlighted. It is suggested that the premature disappearance of intrathecal synthesis of a specific anti-HSV antibody might play a permissive role in the resurgence of cerebral viral replication.
一名5岁女性出现右侧无热惊厥持续发作、右侧臂面瘫和构音障碍，意识未改变。发热在神经症状出现20小时后出现。入院时（第1天），脑计算机断层扫描和脑脊液（CSF）分析均正常，包括未检测到α-干扰素（α-IFN）且单纯疱疹病毒（HSV）聚合酶链反应（PCR）阴性。开始使用阿昔洛韦，剂量为60mg/kg/天，持续21天，神经症状有所改善。脑磁共振成像（MRI）显示左侧丘脑和左侧顶叶有病变。第8天，脑脊液白细胞计数升高，以淋巴细胞为主，但仍未检测到α-IFN和HSV DNA。在第26天发现特异性抗HSV抗体鞘内合成延迟，确诊为单纯疱疹病毒性脑炎（HSE）。此次发作20个月后，患者出现发热性脑膜综合征。PCR检测到脑脊液中有HSV DNA，脑成像显示左侧颞叶有新病变。复发开始时，特异性抗HSV抗体鞘内合成消失。开始使用阿昔洛韦，剂量为60mg/kg/天，持续21天，神经状态改善。出院时，神经检查显示右侧偏瘫和口面部失用。强调了儿童HSE诊断中的问题。提示特异性抗HSV抗体鞘内合成过早消失可能在脑病毒复制复发中起允许作用。
