Mikati M A, Feraru E, Krishnamoorthy K, Lombroso C T
Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Neurology. 1990 Sep;40(9):1433-7. doi: 10.1212/wnl.40.9.1433.
We studied the sequential EEGs of 15 neonatal herpes simplex virus meningoencephalitis (NHSV-ME) patients and correlated them with corresponding clinical and laboratory findings. During days 1 to 4 of the illness, 8 had EEGs. All but 1 had abnormal tracings and 3 (38%) showed the multifocal periodic pattern (MPP). Three had an early abnormal EEG at a time when their cranial CT/ultrasound studies were normal. During days 5 to 11, 13 had EEGs: all were abnormal and 3 showed the MPP. After day 11, EEGs (available on 10) showed a very low voltage background in 9, and only 1 had normal EEG and development. During 1 year in which 1 patient with NHSV-ME was observed, we noted that 9/324 (2.8%) of neonates with other CNS conditions manifested the MPP. All, however, had CSF findings that distinguished them from herpes cases. We conclude that: (1) In patients with suspected NHSV-ME, EEG is a sensitive test that is superior to radiologic procedures in detecting early cerebral involvement. Most of the early EEGs show nonspecific background and paroxysmal abnormalities. (2) In the presence of inflammatory CSF, the MPP, an otherwise nonspecific finding, is highly suggestive of NHSV-ME. (3) Sequential EEGs may be important in the follow-up of neonates with NHSV-ME.
我们研究了15例新生儿单纯疱疹病毒性脑膜脑炎（NHSV-ME）患者的系列脑电图，并将其与相应的临床和实验室检查结果进行关联。在疾病的第1至4天，15例中有8例进行了脑电图检查。除1例以外，其余脑电图均异常，3例（38%）表现为多灶性周期性模式（MPP）。3例在头颅CT/超声检查正常时脑电图就出现早期异常。在第5至11天，15例中有13例进行了脑电图检查：所有结果均异常，3例表现为MPP。第11天之后，10例进行脑电图检查的患者中，9例背景电压极低，只有1例脑电图及发育正常。在观察1例NHSV-ME患者的1年期间，我们注意到，324例患有其他中枢神经系统疾病的新生儿中有9例（2.8%）表现出MPP。然而，所有这些患儿的脑脊液检查结果均与疱疹病例不同。我们得出以下结论：（1）对于疑似NHSV-ME的患者，脑电图是一项敏感的检查，在检测早期脑受累方面优于放射学检查。大多数早期脑电图表现为非特异性背景及阵发性异常。（2）在脑脊液有炎症的情况下，MPP（否则为非特异性表现）高度提示NHSV-ME。（3）系列脑电图检查对于NHSV-ME新生儿的随访可能很重要。
