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Abstract: Herpes simplex encephalitis is an infectious disease of the central nervous system caused by herpes simplex virus infection. The patient in this case was a 49-year-old female with persistent fever, cough and other symptoms of upper respiratory tract infection, and poor results of self-administered cold medication with limb twitching. The diagnosis of herpes simplex virus encephalitis was made by perfecting cranial magnetic resonance as well as blood sampling and laboratory tests. After being admitted to the hospital for aggressive drug treatment, the patient’s condition was stable with no significant sequelae and her symptoms improved.
[Basic information] Female, 49 years old
Disease Type】Herpes simplex virus encephalitis
Hospital】Shandong Provincial Third Hospital
Time of consultation】May 2018
Treatment plan】Medication (injectable ganciclovir + mannitol injection + dexamethasone sodium phosphate injection)
Treatment period】Inpatient treatment for 10 days, outpatient follow-up after 1 month
Treatment effect】Stable condition, no obvious sequelae, symptoms improved
I. Initial consultation
The first time I saw the patient, he was transferred to the hospital from a lower level hospital. When the patient arrived at the hospital, her symptoms were severe, she was drowsy and her body temperature was high, fluctuating around 38℃, accompanied by paroxysmal limb convulsions. According to the patient’s family, he had no previous medical history, but had persistent fever, cough and other symptoms of upper respiratory tract infection 3 days ago, and the effect of self-administered cold medicine was not good. The family immediately transferred the patient to our hospital, where the outpatient cranial magnetic resonance imaging (MRI) was completed, suggesting abnormal signals in the brain, and the possibility of herpes simplex virus The possibility of herpes simplex virus encephalitis was considered.
II. Treatment history
At present, the patient was unconscious, accompanied by limb convulsions, and was considered to have intracranial infection with secondary abnormal brain generation. The results of the lumbar puncture indicated that the cerebrospinal fluid was tested for brain pressure of 200 mmHg, a strong positive Pan’s test, a white blood cell count of 56×10^9/L, 95% classified lymphocytes, cerebrospinal fluid protein of 805 mg/L, sugar of 3.28 mmol/L, and chloride of 105 mmol/L. The electroencephalogram indicated diffuse high-amplitude slow waves, and the patient’s condition was serious. The patient was given injectable ganciclovir, mannitol injection and dexamethasone sodium phosphate injection after detailed communication with the patient’s family. 3 days later, the indexes were significantly better than before, suggesting that the treatment was effective, and the patient was advised to do a good job of nutritional support and nursing care.
III. Treatment effect
Herpes simplex virus encephalitis is an intracranial neurological disease caused by herpes simplex virus infection, and the symptoms of acute attack are relatively heavy. Early treatment is effective, and antiviral immunotherapy as well as symptomatic treatment given immediately after clear diagnosis can have significant effects. The patient gradually regained consciousness in 3 days through active drug treatment; after 5 days, the patient could get out of bed and walk and eat on his own; in about 10 days, the patient was assessed to have basically normal cognitive function and move freely without obvious sequelae, and the treatment effect was good, so the patient was discharged from the hospital. The patient had no significant discomfort and other symptoms after 1 month of follow-up visit.
IV. Notes
The patient in this case was actively treated and regularly followed up and recovered well, so we are sincerely happy for his recovery. However, it is recommended that the patient be discharged from the hospital, and during the consolidation period, he should also take the medication regularly and in full, avoid stopping the medication without authorization, and follow up promptly. Patients are advised to rest in bed, and the head of the bed can be appropriately elevated by about 30° to reduce cerebral edema; in daily life, patients are advised to eat high-calorie, high-vitamin and high-protein foods to ensure adequate nutrition, and they should drink more than 1000ml of water every day. If there are seizures during the convalescence period at home after discharge from the hospital, braking should be done to avoid falling out of bed, pay attention to keep the airway open, massage the limbs to promote blood circulation, and turn the patient regularly to avoid pressure sores.
V. Personal insight
Herpes simplex virus encephalitis has a greater impact on the health of the patient. If the sequelae of neurological dysfunction occur without timely treatment, it will seriously affect the life of patients. Therefore, you should actively exercise to improve your body immunity; people who have the conditions can be injected with the corresponding vaccine to prevent the occurrence of the disease. If the symptoms of the above-mentioned diseases appear, such as persistent fever and convulsions, you should immediately consult a hospital and need to improve relevant examinations to exclude possible diseases, improve the accuracy of diagnosis and treatment, and give medication to avoid delaying the disease and affecting the treatment effect.