Herpes simplex virus infection limited to the brainstem
Herpes simplex virus infection limited to the brainstem
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DOI：
10.1007/s00508-005-0324-0
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发表时间：
2005-07-01
影响因子：
2.6
通讯作者：
Popovic, M
中科院分区：
文献类型：
--
作者：
Jereb, M;Lainscak, M;Popovic, M
局灶性脑膜脑炎通常由单纯疱疹病毒感染引起，通常影响颞叶或额叶，如不治疗，死亡率为70%。然而，在极少数情况下，感染仅限于脑干。脑脊液聚合酶链反应分析是诊断单纯疱疹脑炎的金标准。一名46岁男性，因头痛和发热高达39℃3天入院。脑脊液检查结果符合无菌性脑膜炎。住院第3天，患者出现复视伴混淆，并出现凝视性瘫。病情从麻木迅速发展为昏迷。第二次脑脊液检查显示低血糖（1.2 mmol/1），并开始使用头孢噻肟和氨苄西林。所有脑脊液标本均未检出细菌和真菌。血清1型单纯疱疹病毒IgG抗体未见鞘内特异性抗体合成。发病第7天对脑脊液样本进行聚合酶链反应分析，单纯疱疹病毒1型和2型呈阴性。大脑的电脑断层扫描没有显示任何异常。尽管进行了抗菌素和支持性重症监护，但患者病情逐渐恶化，并于入院后第11天死亡。尸检显示出出血和坏死性脑干脑膜脑炎，并通过原位杂交证实单纯疱疹病毒1型感染。如果不治疗，单纯疱疹病毒脑炎的死亡率为70%。感染部位不典型，临床表现不典型，影像学和微生物学检查阴性，可能是误诊和误治的原因。许多作者主张对任何不明原因脑病患者使用经年性阿昔洛韦，因为延迟治疗可能会极大地影响结果。我们描述了一个因脑干感染单纯疱疹病毒1型脑炎而死亡的病人，在那里通过原位杂交发现了尸检后的核酸。在极少数情况下，单纯疱疹病毒感染以及临床表现和病理改变仅限于脑干。
Focal meningoencephalitis is commonly caused by Herpes simplex virus infection, which typically affects temporal or frontal lobes, and carries a mortality rate of 70% if untreated. On rare occasions, however, the infection is restricted to the brain stem. Polymerase chain reaction analysis of cerebrospinal fluid is the gold standard for the diagnosis of herpes simplex encephalitis.A 46-year-old male was admitted to the hospital with a three day history of headache and fever up to 39 degrees C. Cerebrospinal fluid findings were in accordance with aseptic meningitis. On the third hospital day, the patient presented with double vision followed by confusion, and gaze paresis developed. The condition rapidly progressed from stupor to coma. A second examination of cerebrospinal fluid revealed a low glucose level (1.2 mmol/1) and cefotaxime with ampicillin were started empirically. All cerebrospinal fluid specimens were negative for bacteria and fungi. Serum IgG antibodies for herpes simplex virus type 1 were found with no intrathecal specific antibody synthesis. A polymerase chain reaction analysis of cerebrospinal fluid sample performed on the seventh day of his illness was negative for herpes simplex virus 1 and 2. A computer tomography scan of the brain did not show any abnormality. Despite antimicrobial and supportive intensive care, the condition of the patient progressively deteriorated and he died on the 11th day after admission. An autopsy revealed hemorrhagic and necrotic brainstem meningoencephalitis, and herpes simplex virus type 1 infection was confirmed by hybridization in situ.Herpes simplex virus encephalitis carries a mortality rate of 70% if untreated. The atypical location of the infection, as well as an atypical clinical manifestation with negative radiological and microbiological tests could be the reasons for false diagnoses and mistreatment. Many authors advocate the use of empiric acyclovir in any patients with unexplained encephalopathy, since delay in treatment may greatly affect outcome.We describe a patient who died due to a herpes simplex virus 1 encephalitis affecting the brainstem, where nucleic acids were found post-mortem by in situ hybridization. On rare occasions, the herpes simplex viral infection as well as clinical manifestations and pathological changes are restricted solely to the brainstem.