Med Hypotheses. 2010 May;74(5):798-801. doi: 10.1016/j.mehy.2009.12.012. Epub 2010 Jan 8.
Twenty years ago, circumstantial evidence was compiled to link the 1918 pandemic influenza virus to a CNS disorder called epidemic encephalitis or encephalitis lethargica. A challenge was issued to naysayers. During the past two decades, the knowledge about the influenza virus and the 1918 pandemic virus in particular has had dramatic advancement. The 1918 virus has been resurrected and reconstructed. Experimental studies of mice inoculated with a neurovirulent avian virus have delineated the neuropathology of influenza encephalitis. Review of autopsy cases of encephalitis lethargica revealed that the neuropathology during and shortly after the pandemic was unique. Surprisingly two different viruses were involved with the great pandemic. A single amino acid difference in the hemagglutinin of the two viruses changed the preferred receptor of the virus in the host cell. One virus has qualities that suggest that it is neurovirulent. Circumstantial evidence suggests that the cause of death in some influenza patients was neurogenic congestive heart failure with pulmonary edema. Theories about the pathophysiology of encephalitis lethargica and postencephalitic Parkinson's disease are offered.
二十年前，有间接证据将 1918 年大流感病毒与一种中枢神经系统疾病（称为流行性脑炎或昏睡性脑炎）联系起来。有人对怀疑论者提出了挑战。在过去的二十年中，人们对流感病毒，特别是 1918 年大流感病毒的了解取得了显著进展。1918 年病毒已经被复活并重建。用神经毒性禽流感病毒接种的实验研究详细描述了流感脑炎的神经病理学。对昏睡性脑炎的尸检病例进行回顾发现，大流行期间和之后的神经病理学是独特的。令人惊讶的是，两种不同的病毒与这场大流行有关。两种病毒的血凝素上只有一个氨基酸的差异，就改变了病毒在宿主细胞中的偏好受体。一种病毒具有神经毒性的特征。间接证据表明，一些流感患者的死因是神经源性充血性心力衰竭伴肺水肿。本文还提出了关于昏睡性脑炎和脑炎后帕金森病的病理生理学理论。
