Domingues R B, Fink M C, Tsanaclis A M, de Castro C C, Cerri G G, Mayo M S, Lakeman F D
Virology Laboratory-Tropical Medicine Institute, University of São Paulo, Brazil.
J Neurol Sci. 1998 May 7;157(2):148-53. doi: 10.1016/s0022-510x(98)00069-0.
The early diagnosis of herpes simplex encephalitis (HSE) is essential because early introduction of antiviral therapy can significantly reduce the mortality of this disease. Herpes simplex virus (HSV) DNA detection in cerebrospinal fluid (CSF) samples is a rapid, noninvasive, specific, and highly sensitive method for HSE diagnosis. Neurodiagnostic methods have also been studied for noninvasive diagnosis of HSE. Magnetic resonance imaging (MRI) seems to be the most sensitive of them but it has not been compared to PCR in terms of efficacy for HSE diagnosis. In this study, 17 patients with focal encephalitis were prospectively evaluated by PCR analysis of CSF samples and MRI examination. MRI lesions involving the inferomedial region of one or both temporal lobes were observed in all PCR-positive patients but one. No PCR-negative patient presented with the same pattern of MRI lesions. MRI was also important for the establishment of an alternative diagnosis in three of eight PCR-negative patients. Both methods should be routinely applied in the evaluation of presumed HSE cases.
单纯疱疹性脑炎（HSE）的早期诊断至关重要，因为早期使用抗病毒治疗可显著降低该病的死亡率。检测脑脊液（CSF）样本中的单纯疱疹病毒（HSV）DNA是一种用于HSE诊断的快速、无创、特异且高度灵敏的方法。人们也对神经诊断方法进行了研究，用于HSE的无创诊断。磁共振成像（MRI）似乎是其中最灵敏的，但就HSE诊断的效能而言，尚未与聚合酶链反应（PCR）进行比较。在本研究中，通过对CSF样本进行PCR分析和MRI检查，对17例局灶性脑炎患者进行了前瞻性评估。除1例患者外，所有PCR阳性患者均观察到累及一侧或双侧颞叶内下区域的MRI病变。没有PCR阴性患者出现相同的MRI病变模式。MRI对于8例PCR阴性患者中的3例确立替代诊断也很重要。这两种方法都应常规应用于疑似HSE病例的评估。
