Ginsberg L, Compston D A
University of Cambridge Neurology Unit, Addenbrooke's Hospital, UK.
Q J Med. 1994 Mar;87(3):169-80.
Sixty-five patients with a diagnosis of acute encephalitis or encephalopathy were discharged from a regional neurological unit over a 17-year period. Investigation during the acute illness, or subsequent clinical and laboratory observations, yielded a definite or probable diagnosis in 34 of these patients, including herpes simplex encephalitis (8 cases), encephalitis due to other identified viruses (7 cases), vascular disease (7 cases) and multiple sclerosis (4 cases). In these 34 patients, mortality relating to the presenting illness was 50% and a further 29% had significant long-term neurological morbidity. In the other 31 patients, no cause for the encephalopathy was identified, despite extensive investigation. These patients had an alteration in conscious state, often with recurrent seizures (45%), focal neurological signs (52%), pyrexia (65%), abnormal electroencephalogram (85%) and cerebrospinal fluid lymphocytosis (80%). During follow-up (6 months to 15 years) none had recurrent encephalopathy, and 65% eventually made a complete recovery, although delayed by seizures in 6% and psychiatric illness in 13%. The mortality in this group relating to the acute illness was 6%. Overall, nearly half the patients with a discharge diagnosis of acute encephalitis or encephalopathy had a good prognosis for recovery, following a monophasic illness of undetermined cause.
在17年的时间里，65名诊断为急性脑炎或脑病的患者从一个地区性神经科病房出院。在急性疾病期间进行的调查，或随后的临床和实验室观察，在其中34名患者中得出了明确或可能的诊断，包括单纯疱疹性脑炎（8例）、其他已确定病毒引起的脑炎（7例）、血管疾病（7例）和多发性硬化症（4例）。在这34名患者中，与当前疾病相关的死亡率为50%，另有29%有严重的长期神经功能障碍。在其他31名患者中，尽管进行了广泛调查，但仍未确定脑病的病因。这些患者有意识状态改变，常伴有反复发作的癫痫（45%）、局灶性神经体征（52%）、发热（65%）、脑电图异常（85%）和脑脊液淋巴细胞增多（80%）。在随访期间（6个月至15年），无人出现复发性脑病，65%最终完全康复，尽管6%因癫痫发作延迟，13%因精神疾病延迟。该组与急性疾病相关的死亡率为6%。总体而言，近一半出院诊断为急性脑炎或脑病的患者，在病因不明的单相疾病后恢复预后良好。
