Hokkanen L, Poutiainen E, Valanne L, Salonen O, Iivanainen M, Launes J
Department of Neurology, University of Helsinki, Finland.
J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):478-84. doi: 10.1136/jnnp.61.5.478.
To compare the cognitive defects after acute acyclovir treated herpes simplex encephalitis with those after other types of acute encephalitis.
Seventy seven consecutive patients between 1985 and 1995 and 29 normal controls were studied. Of the 77 patients without concomitant neurological conditions, 17 had herpes simplex, one virus encephalitis (HSVE group), 27 had some other identified aetiology (non-HSVE group), and in 33 patients the cause was unknown. Acyclovir treatment was started less than four days after the first mental symptoms in 12 of 17 patients with HSVE. A thorough neuropsychological assessment was carried out about one month after the onset.
The HSVE group had deficits in verbal memory, verbal-semantic functions, and visuoperceptual functions more often than the non-HSVE group. The risk for cognitive defects was twofold to four-fold in the patients with HSVE compared with the non-HSVE patients. Two (12%) of the patients with HSVE and 12 (44%) of the non-HSVE patients were cognitively intact. Six patients with HSVE (46%) and 17 (89%) non-HSVE patients later returned to work. The lesions on CT or MRI were bilateral only in one patient with HSVE. The defects in the three patients with adenovirus infection were severe and resembled the amnesia after HSVE. Cognitive impairment, not previously reported, was found in encephalitis after rotavirus infection and epidemic nephropathy.
The recovery in the HSVE group was better than expected based on the medical literature. On the other hand there were surprisingly severe cognitive defects in encephalitis after other viruses. With early acyclovir treatment patients with the least severe HSVE were equivalent to those with non-HSV encephalitis with good outcome whereas those with the most severe non-HSV encephalitis were equivalent to those with HSVE with poor outcome.
比较急性阿昔洛韦治疗的单纯疱疹病毒性脑炎与其他类型急性脑炎后的认知缺陷。
对1985年至1995年间连续收治的77例患者和29名正常对照者进行研究。在这77例无合并神经系统疾病的患者中，17例为单纯疱疹病毒性脑炎（HSVE组），1例为病毒脑炎，27例有其他明确病因（非HSVE组），33例病因不明。17例HSVE患者中有12例在出现首发精神症状后不到4天开始阿昔洛韦治疗。发病后约1个月进行全面的神经心理学评估。
HSVE组在言语记忆、言语语义功能和视觉感知功能方面的缺陷比非HSVE组更常见。与非HSVE患者相比，HSVE患者出现认知缺陷的风险高出两倍至四倍。HSVE组中有2例（12%）患者认知功能正常，非HSVE组中有12例（44%）患者认知功能正常。6例HSVE患者（46%）和17例（89%）非HSVE患者后来恢复工作。CT或MRI上的病变仅在1例HSVE患者中为双侧性。3例腺病毒感染患者的缺陷严重，类似于HSVE后的失忆症。在轮状病毒感染后脑炎和流行性肾病中发现了此前未报道的认知障碍。
基于医学文献，HSVE组的恢复情况好于预期。另一方面，其他病毒感染后脑炎出现了令人惊讶的严重认知缺陷。早期使用阿昔洛韦治疗时，病情最轻的HSVE患者与预后良好的非HSV脑炎患者相当，而病情最严重的非HSV脑炎患者与预后不良的HSVE患者相当。
