Departmentsof Neurology,Rhode Island Hospital/Warren Alpert School of Medicine at Brown University, 593 Eddy Street, APC 712, Providence, RI 02903, USA.
Neurocrit Care. 2013 Aug;19(1):111-5. doi: 10.1007/s12028-013-9822-5.
Eastern Equine Encephalitis (EEE) virus is an arbovirus that mostly causes asymptomatic infection in humans; however, some people can develop a neuroinvasive infection associated with a high mortality.
We present a case of a patient with severe neuroinvasive EEE.
A 21-year-old man initially presented with headache, fever, and vomiting and was found to have a neutrophilic pleocytosis in his cerebrospinal fluid. He eventually was diagnosed with EEE, treated with high-dose methylprednisolone and intravenous immunoglobulin. His course in the NeuroIntensive Care Unit was complicated by cerebral edema and intracranial hypertension, requiring osmotherapy, pentobarbital and placement of an external ventricular device, and subclinical seizures, necessitating multiple anti-epileptic drugs
A multifaceted approach including aggressive management of cerebral edema and ICP as well as treatment with immunomodulating agents and cessation of seizures may prevent brain herniation, secondary neurologic injury and death in patients with EEE. Effective management and treatment in our patient contributed to a dramatic recovery and ultimate good outcome.
东部马脑炎（EEE）病毒是一种虫媒病毒，主要在人类中引起无症状感染；然而，有些人可能会发展为与高死亡率相关的神经侵袭性感染。
我们报告了一例重症神经侵袭性 EEE 患者的病例。
一名 21 岁男性最初表现为头痛、发热和呕吐，其脑脊液中发现中性粒细胞增多。他最终被诊断为 EEE，并接受大剂量甲基强的松龙和静脉注射免疫球蛋白治疗。他在神经重症监护病房的病程中并发脑水肿和颅内压升高，需要进行渗透性治疗、戊巴比妥和放置外部脑室引流装置，以及亚临床癫痫发作，需要使用多种抗癫痫药物。
包括积极管理脑水肿和 ICP 以及使用免疫调节药物和停止癫痫发作在内的多方面方法可能预防 EEE 患者的脑疝、继发性神经损伤和死亡。我们的患者的有效管理和治疗有助于其显著恢复并最终获得良好结局。
