Turkulov V, Madle-Samardzija N, Ilić A, Vukadinov J, Canak G
Klinika za infektivne i dermatoveneroloske bolesti, Medicinski fakultet, Novi Sad.
Med Pregl. 1998 Sep-Oct;51(9-10):436-40.
A great number of various viruses are stated as the cause of acute infections and damages of the central nervous system. In most cases these are minor damages which exhibit as meningeal syndrome and a specific finding in the cerebrospinal fluid. According to the dominant location, central nervous system infections can take a form of meningitis, encephalitis or myelitis. Since the inflammatory process of the meninges can not be separated from the inflammatory process of the brain, we usually speak of meningoencephalitis. The etiological diagnosis of meningitis and encephalitis is established by isolating the virus from the cerebrospinal fluid and by finding the presence of the specific antibodies in the blood and in the cerebrospinal fluid. The most common causes of the viral meningitis are Enteroviruses, the Mumps virus, Arthropode borne viruses, the Herpes viruses, Adeno viruses and the Lymphocytic choriomeningitis virus. The aim of our study was to establish the correlation between the clinical features and immunological and cerebrospinal fluid changes and the degree of the damage to the blood-brain barrier during the infections of the central nervous system, caused by the Herpes Simplex virus and the Lymphocytic choriomeningitis virus.
From a group of 103 patients, who had been treated for viral meningitis and meningoencephalitis, a group of 27 patients with established specific viral etiology--Herpes Simplex virus and Lymphocytic choriomeningitis virus, had been taken into the account. Herpes Simplex infection had been proven by the complement binding reaction and the neutralisation test of the even samples of serum. The diagnosis of Lymphocytic choriomeningitis was confirmed by the immunofluorescence test of the pharynx swabs and cerebrospinal fluid. The clinical features, such as body temperature, encephalitic signs, and electroencephalographic findings had been followed and compared.
Herpes Simplex infection had been found in 20 patients, Lymphocytic choriomeningitis had been proven in 7 patients. All the patients had increased body temperature. Only four of the patients exhibited encephalitic signs, all infected by the Herpes Simplex virus. Patients from the Herpes Simplex group showed various degrees of consciousness disturbances, ranging from somnolence to coma, while the Lymphocytic choriomeningitis patients exhibited none. Higher pleocytosis and protein level had been found in the Lymphocytic choriomeningitis group.
Viral diseases of the central nervous system are the result of the direct damage of the brain and meninges by the virus and immunological processes. Herpes Simplex meningitis usually has a good prognosis. Lymphocytic choriomeningitis has longer course of the disease and exhibits more severe clinical features.
In cases of the central nervous system infections, caused by Herpes Simplex virus or Lymphocytic choriomeningitis virus, the correlation between the severeness of clinical features and the degree of damage of the blood-brain barrier, the level of pleocytosis and the increase of the cerebrospinal fluid proteins had been established.
大量不同病毒被认为是中枢神经系统急性感染和损伤的病因。在大多数情况下，这些都是轻微损伤，表现为脑膜综合征和脑脊液中的特定发现。根据主要发病部位，中枢神经系统感染可表现为脑膜炎、脑炎或脊髓炎。由于脑膜的炎症过程与脑的炎症过程无法分开，我们通常称之为脑膜脑炎。脑膜炎和脑炎的病因诊断是通过从脑脊液中分离病毒以及在血液和脑脊液中发现特异性抗体来确立的。病毒性脑膜炎最常见的病因是肠道病毒、腮腺炎病毒、节肢动物传播病毒、疱疹病毒、腺病毒和淋巴细胞性脉络丛脑膜炎病毒。我们研究的目的是确定由单纯疱疹病毒和淋巴细胞性脉络丛脑膜炎病毒引起的中枢神经系统感染期间，临床特征与免疫和脑脊液变化以及血脑屏障损伤程度之间的相关性。
从一组103例接受病毒性脑膜炎和脑膜脑炎治疗的患者中，选取了27例已确定特定病毒病因（单纯疱疹病毒和淋巴细胞性脉络丛脑膜炎病毒）的患者。单纯疱疹感染通过血清匀浆样本的补体结合反应和中和试验得到证实。淋巴细胞性脉络丛脑膜炎的诊断通过咽拭子和脑脊液的免疫荧光试验得到确认。对体温、脑炎体征和脑电图检查结果等临床特征进行了跟踪和比较。
20例患者被发现感染单纯疱疹病毒，7例患者被证实感染淋巴细胞性脉络丛脑膜炎病毒。所有患者体温均升高。只有4例患者出现脑炎体征，均为单纯疱疹病毒感染。单纯疱疹病毒组的患者表现出不同程度的意识障碍，从嗜睡到昏迷，而淋巴细胞性脉络丛脑膜炎患者则无此表现。淋巴细胞性脉络丛脑膜炎组的脑脊液细胞数增多和蛋白水平更高。
中枢神经系统的病毒性疾病是病毒对脑和脑膜的直接损伤以及免疫过程的结果。单纯疱疹性脑膜炎通常预后良好。淋巴细胞性脉络丛脑膜炎病程较长，临床特征更严重。
在由单纯疱疹病毒或淋巴细胞性脉络丛脑膜炎病毒引起的中枢神经系统感染病例中，已确立临床特征的严重程度与血脑屏障损伤程度、脑脊液细胞数增多水平和脑脊液蛋白升高之间的相关性。
