Kohl S, James A R
J Pediatr. 1985 Aug;107(2):212-5. doi: 10.1016/s0022-3476(85)80127-x.
Twelve consecutive pediatric patients 1 day to 11 years of age with suspected herpes simplex virus (HSV) encephalitis underwent brain biopsy. Five were proved to have HSV encephalitis; seven had subdural empyema, malignant glioma, enteroviral encephalitis, (one each), and presumed viral encephalitis, non-HSV (four). Neither epidemiologic, clinical, nor noninvasive laboratory tests were able to help differentiate the two groups of patients. The EEG was more sensitive than the CT scan in demonstrating focal lesions in early HSV encephalitis. In patients with HSV encephalitis, the mean time from hospital admission to appropriate antiviral chemotherapy was 3 days, and the outcome of HSV encephalitis was uniformly poor. In patients with febrile encephalitis-like syndromes with CSF pleocytosis, focal neurologic signs, or other localizing test results (EEG, CT), anticipatory antiviral chemotherapy and brain biopsy are the only hope to prevent the poor outcome associated with HSV encephalitis, to exclude other treatable conditions, and to avoid multiple types of unnecessary empiric therapies.
12例年龄在1天至11岁之间疑似单纯疱疹病毒（HSV）脑炎的儿科患者接受了脑活检。其中5例被证实患有HSV脑炎；7例分别患有硬膜下积脓、恶性胶质瘤、肠道病毒性脑炎，以及疑似病毒性脑炎（非HSV，共4例）。流行病学、临床或非侵入性实验室检查均无法帮助区分这两组患者。在早期HSV脑炎中，脑电图在显示局灶性病变方面比CT扫描更敏感。在患有HSV脑炎的患者中，从入院到开始适当抗病毒化疗的平均时间为3天，HSV脑炎的预后普遍较差。对于患有发热性脑炎样综合征且脑脊液淋巴细胞增多、有局灶性神经体征或其他定位检查结果（脑电图、CT）的患者，预防性抗病毒化疗和脑活检是预防与HSV脑炎相关的不良预后、排除其他可治疗疾病以及避免多种不必要经验性治疗的唯一希望。
