Elbers Jorina M, Bitnun Ari, Richardson Susan E, Ford-Jones Elizabeth L, Tellier Raymond, Wald Rachel M, Petric Martin, Kolski Hanna, Heurter Helen, MacGregor Daune
Division of Neurology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, M5G 1X8, Canada.
Pediatrics. 2007 Feb;119(2):e399-407. doi: 10.1542/peds.2006-1494.
The purpose of this study was to review the experience with herpes simplex encephalitis at the Hospital for Sick Children over the past 12 years.
All patients who were admitted to our institution with acute encephalitis between January 1994 and December 2005 were enrolled prospectively in an encephalitis registry. Children from the registry with herpes simplex encephalitis were included in this study; we detailed the clinical presentations, laboratory findings, electroencephalographic findings, diagnostic imaging findings, treatments, and outcomes for all cases.
Of 322 cases of acute encephalitis, 5% were caused by herpes simplex virus. Initially negative herpes simplex virus cerebrospinal fluid polymerase chain reaction results were found in 2 cases (13%), but results became positive in repeat cerebrospinal fluid analyses. Classic clinical presentations were seen in 75% of cases, cerebrospinal fluid pleocytosis was found in 94%, elevated cerebrospinal fluid protein levels were found in 50%, electroencephalographic changes were observed in 94%, and diagnostic imaging abnormalities were noted in 88%. All patients were treated with intravenous acyclovir. Neurologic sequelae occurred in 63% of cases, including seizures in 44% and developmental delays in 25%. There were no deaths in this study group.
Herpes simplex encephalitis continues to be associated with poor long-term neurologic outcomes despite appropriate therapy. Cerebrospinal fluid polymerase chain reaction results may be negative early in the course of herpes simplex encephalitis; therefore, repeat cerebrospinal fluid analysis should be considered if herpes simplex encephalitis is suspected. Atypical forms of herpes simplex virus central nervous system disease may occur in children.
本研究旨在回顾过去12年里病童医院（The Hospital for Sick Children）在单纯疱疹病毒性脑炎方面的经验。
1994年1月至2005年12月期间入住我院的所有急性脑炎患者均被前瞻性纳入脑炎登记系统。该研究纳入了登记系统中患有单纯疱疹病毒性脑炎的儿童；我们详细记录了所有病例的临床表现、实验室检查结果、脑电图检查结果、诊断性影像学检查结果、治疗方法及预后情况。
在322例急性脑炎病例中，5%由单纯疱疹病毒引起。2例（13%）患者最初的单纯疱疹病毒脑脊液聚合酶链反应结果为阴性，但在重复脑脊液分析时结果转为阳性。75%的病例有典型临床表现，94%的病例脑脊液有细胞增多，50%的病例脑脊液蛋白水平升高，94%的病例观察到脑电图改变，88%的病例有诊断性影像学异常。所有患者均接受静脉注射阿昔洛韦治疗。63%的病例出现神经后遗症，其中44%有癫痫发作，25%有发育迟缓。该研究组无死亡病例。
尽管进行了适当治疗，单纯疱疹病毒性脑炎仍与长期不良神经预后相关。在单纯疱疹病毒性脑炎病程早期，脑脊液聚合酶链反应结果可能为阴性；因此，如果怀疑为单纯疱疹病毒性脑炎，应考虑重复进行脑脊液分析。儿童可能会出现非典型形式的单纯疱疹病毒中枢神经系统疾病。
