Gordon B, Selnes O A, Hart J, Hanley D F, Whitley R J
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 21205.
Arch Neurol. 1990 Jun;47(6):646-7. doi: 10.1001/archneur.1990.00530060054017.
Survival from untreated herpes simplex type 1 encephalitis is well known to be accompanied by severe cognitive impairments. Recently, acyclovir has been proven to be the most effective available treatment for this disease, with the expectation that it would appreciably reduce morbidity. We performed detailed assessments of four consecutive patients who received acyclovir in the early stages of biopsy-proven herpes encephalitis and who now have been followed up for 1.5 to 4 years. All four patients showed definite residual on either clinical or formal neuropsychological testing, most commonly dysnomia and impaired new learning for both verbal and visual material, even though three had normal performance on a standard clinical mental status test. All four patients were unable to function at their prior level of achievement. Therefore, despite early administration of acyclovir in herpes encephalitis, long-lasting neuropsychological residua are likely. Furthermore, cognitive deficits of prognostic importance may not be detected by clinical screening.
未经治疗的单纯疱疹病毒1型脑炎患者存活后常伴有严重的认知障碍，这是众所周知的。最近，阿昔洛韦已被证明是治疗该疾病最有效的药物，人们期望它能显著降低发病率。我们对4例经活检证实为疱疹性脑炎且在早期接受阿昔洛韦治疗的连续患者进行了详细评估，目前他们已接受了1.5至4年的随访。所有4例患者在临床或正式神经心理学测试中均显示出明确的残留症状，最常见的是命名障碍以及对言语和视觉材料的新学习能力受损，尽管其中3例在标准临床精神状态测试中表现正常。所有4例患者均无法恢复到之前的成就水平。因此，尽管在疱疹性脑炎中早期使用了阿昔洛韦，但仍可能存在长期的神经心理学残留症状。此外，临床筛查可能无法检测出具有预后重要性的认知缺陷。
