I. Diagnostic points.
1, any age can be affected, but children under 10 years old and young people between 20 and 30 years old are the most common.
2, more acute onset. A small number of subacute or chronic onset chronic onset.
3. Neuropsychiatric symptoms: headache, nausea and vomiting, convulsions, impaired consciousness, psychiatric symptoms, hemiplegia, aphasia, etc.
4. Evidence of infection: fever, mild to moderate elevation of blood WBC.
5. EEG often shows diffuse high-amplitude slow waves, with unilateral or bilateral temporal and frontal abnormalities more obvious, and even spikes and spines in the temporal region.
6, imaging: cranial CT can be normal, but also visible on one or both temporal lobes, hippocampus and limbic system focal hypodense areas; if the hypodense lesions appear dotted high-density shadow suggests hemorrhagic necrosis in the temporal lobe, more support the diagnosis of herpes simplex virus encephalitis. Cranial MRI helps to detect foci with long T1 and long T2 signals in the brain parenchyma.
7, cerebrospinal fluid examination: pressure is normal or mildly increased, in severe cases can be significantly increased, the number of cells significantly increased, mainly single nucleated cells, there may be an increase in the number of red blood cells, except lumbar puncture injury is indicative of hemorrhagic necrotizing encephalitis; protein is mildly or moderately increased, sugar and chloride is normal.
8, cerebrospinal fluid pathogenic examination is quite meaningful for diagnosis. Including.
① detection of HSV antigen ;
② Detection of HSV-specific lgM and lgG antibodies;
(3) detection of HSV-DNA in CSF.
9, brain histopathology: is the most reliable method, some cases need brain biopsy to clarify the diagnosis. The important feature under light microscope is hemorrhagic necrosis; under electron microscope is Cowdry A type inclusion body in the nucleus.
Treatment
1, antiviral drug therapy: acyclic guanosine (acyclovir, Acyclovir): commonly used dose of 15-30ms/(kS・d), divided into 3 intravenous drips, or 500me / time, every 8 hours, intravenous drip, for 14-21 days. Treatment with ganciclovir, cidofovir and sodium phosphonate is also available, especially for acyclovir-resistant HSV strains.
2. Immunotherapy includes.
①Interferon and its inducers: the therapeutic dose of interferon is 60X106IU/day for 30 days of continuous intramuscular injection;
②Transfer factor: the treatment dose is 1 subcutaneous injection each time, 1-2 times a week;
③Adrenocorticotropic hormone: can be used as appropriate for those with critical condition, hemorrhagic necrotic foci seen on cranial CT, and cerebrospinal fluid leukocytes and red blood cells significantly increased; dexamethasone 10-15mg plus 500ml of sugar saline once daily for 10-14 days; methylprednisolone 800-1000mg added to 500ml of sugar saline intravenously once daily for 3 -5 days; then switch to prednisone orally, 80mg daily in the early morning, and gradually reduce the dosage later.
3. Systemic supportive therapy is essential for patients who are seriously ill or in coma, pay attention to maintaining nutrition and water and electrolyte balance, and keep the airway open. If necessary, small amount of blood transfusion, or give intravenous high nutrition or compound amino acids, or give high-dose immunoglobulin intravenous drip; and need to strengthen care, prevent bed sores and respiratory tract infections and other complications.
Symptomatic treatment includes physical cooling for patients with high fever, as well as anticonvulsant, sedation and dehydration to lower cranial pressure, etc. Patients with severe cerebral edema should be given adrenal corticosteroids in large amounts and short courses early.
5.Rehabilitation treatment can be carried out during the recovery period.