Stepien Natalia, Weseslindtner Lukas, Seidl Rainer, Geldner Julia, Golej Johann, Schmook Maria-Theresa, Peyrl Andreas
Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
Center for Virology, Medical University of Vienna, Vienna, Austria.
SAGE Open Med Case Rep. 2020 Dec 6;8:2050313X20977142. doi: 10.1177/2050313X20977142. eCollection 2020.
Headaches in children are a common, but unspecific symptom that can have many underlying causes, ranging from unspecific tension headache through migraine and up to encephalitis and intracranial hypertension. We present the case of a 14-year-old boy who presented to our emergency department with headache, nausea as well as vomiting and developed seizures later on. The initial diagnosis was complicated by a magnetic resonance imaging which did not show any signs of inflammation, but was of limited informative value due to orthodontic appliances. Despite the unremarkable imaging, prophylactic antiviral and antibiotic treatment was started after lumbar puncture. Herpes simplex virus as well as human herpes virus 7 were confirmed in the cerebrospinal fluid. Although both viruses are ubiquitous, severe infections are a rare complication. Immunodeficiency syndromes are predisposing factors for serious complications and genetic analysis of UNC93B and TLR-3 might be helpful for decision-making. No genetic or immunologic predisposition was found in our patient. The patient's condition deteriorated rapidly, so he had to be admitted to the pediatric intensive care unit, where he was intubated and his antiviral treatment with acyclovir was extended by foscarnet. After prolonged mechanical ventilation, he slowly improved. With intensive neurorehabilitation, he could finally return to his daily life activities 3 months after diagnosis. Despite headaches being an unspecific symptom, the possibility of a herpes simplex virus encephalitis should always kept in mind, especially in patients presenting with additional symptoms such as vomiting, altered mental status and/or focal neurological deficits. An initial magnetic resonance imaging might be misleading if orthodontic appliances are in place. Initiation of treatment without delay is crucial for neurologic outcome of herpes simplex virus encephalitis.
儿童头痛是一种常见但不具特异性的症状，可能有多种潜在病因，从不具特异性的紧张性头痛到偏头痛，直至脑炎和颅内高压。我们报告一例14岁男孩，他因头痛、恶心及呕吐就诊于我们的急诊科，随后出现癫痫发作。最初的诊断因磁共振成像而复杂化，该成像未显示任何炎症迹象，但由于正畸矫治器，其信息量有限。尽管成像结果无异常，但在腰椎穿刺后开始了预防性抗病毒和抗生素治疗。脑脊液中证实了单纯疱疹病毒和人疱疹病毒7型。虽然这两种病毒普遍存在，但严重感染是一种罕见的并发症。免疫缺陷综合征是严重并发症的易感因素，对UNC93B和TLR - 3进行基因分析可能有助于决策。我们的患者未发现遗传或免疫易感性。患者病情迅速恶化，因此不得不入住儿科重症监护病房，在那里他接受了插管，并用膦甲酸钠延长了阿昔洛韦的抗病毒治疗。经过长时间的机械通气，他逐渐好转。经过强化神经康复治疗，他在诊断后3个月最终能够恢复日常生活活动。尽管头痛是一种不具特异性的症状，但应始终牢记单纯疱疹病毒性脑炎的可能性，尤其是在出现呕吐、精神状态改变和/或局灶性神经功能缺损等附加症状的患者中。如果存在正畸矫治器，最初的磁共振成像可能会产生误导。对于单纯疱疹病毒性脑炎的神经学预后，及时开始治疗至关重要。
