Jouanny P, Vespignani H, Gérard A, Jeandel C, Ducrocq X, Penin F, Weber M, Dureux J B, Cuny G, Canton P
Service de médecine interne B, CHU de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France.
Rev Med Interne. 1994;15(8):504-9. doi: 10.1016/s0248-8663(05)81479-1.
In a retrospective analysis of 13 cases of Herpes simplex encephalitis (mean age: 67.2 +/- 6.4 years; ten women, three men), the authors conclude that this infection is more often due to Herpes simplex virus 1 in the elderly. Diagnosis is difficult at an early stage, and must be suspected in case of confusion (9/13), especially feverish (11/13), associated with neurological signs (10/13), and particularly epilepsy (5/13). It requires a lumbar puncture which collect a clear and lymphocytic fluid. Prognosis of this encephalitis depends on early diagnosis and an presumptive therapy with acyclovir. EEG is helpful showing periodic activity (10/13). CT scan and MRI can show unspecific abnormalities, but often too late. Laboratory findings will secondarily confirm the diagnosis quite frequently, using new Elisa methods. Polymerase chain reaction allows earlier diagnosis. Geriatric cases seem more often due to reinfection or to endogen virus reactivation rather than to primary infection.
在一项对13例单纯疱疹性脑炎患者（平均年龄：67.2±6.4岁；10名女性，3名男性）的回顾性分析中，作者得出结论，在老年人中，这种感染更多是由单纯疱疹病毒1型引起的。早期诊断困难，在出现意识模糊（13例中有9例），尤其是发热（13例中有11例），伴有神经体征（13例中有10例），特别是癫痫（13例中有5例）的情况下必须怀疑该病。需要进行腰椎穿刺以获取清亮的淋巴细胞性脑脊液。这种脑炎的预后取决于早期诊断和使用阿昔洛韦的推定治疗。脑电图有助于显示周期性活动（13例中有10例）。CT扫描和MRI可能显示非特异性异常，但往往为时已晚。实验室检查结果使用新的酶联免疫吸附测定方法常常能辅助确诊。聚合酶链反应能够实现更早的诊断。老年病例似乎更多是由于再次感染或内源性病毒再激活，而非原发性感染。
