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Abstract: Herpes simplex virus encephalitis mostly has an acute onset. In this article, the patient presented with headache, nausea, vomiting, and impaired consciousness due to overexertion, which was confirmed to be herpes simplex virus encephalitis after examination and subsequent treatment with sodium valproate tablets and mannitol injection.
Basic information】Female, 23 years old
Disease Type】Herpes simplex virus encephalitis
Hospital】Beijing Anzhen Hospital, Capital Medical University
Date of Consultation】March 2021
Treatment plan】Medication (valproate tablets, mannitol injection, ganciclovir for injection, ceftriaxone for injection)
Treatment Period】Hospitalization for 20 days, monthly follow-up
Treatment effect】The disease was basically controlled and the symptoms gradually disappeared.
I. Initial consultation
Patient Xiao Wang is a 23-year-old girl who came to the clinic with symptoms of unconsciousness and short-lived convulsions, and her family was told that the patient had developed persistent brain distension, jet vomiting, nausea and transient unconsciousness after overexertion 7 days ago. He was given an electroencephalogram, which showed possible encephalitis, and his headache was relieved after treatment with fluids. We gave the patient a cranio-cerebral CT examination, which showed that the sulci and pools of the cerebral hemispheres were shallowed bilaterally, and there was a lamellar hypointense shadow in the medial left temporal lobe, which was initially diagnosed as central nervous system infection, and the condition was relatively serious.
II. Treatment history
Basic examination of the patient showed that the patient had a body temperature of 38.5°C, was in a comatose state, the left pupil was 4 mm, the right pupil was 3 mm, the reflex to light was blunted, the limbs were tinglingly flexed and hypotonic, the tendon reflexes of both upper limbs (+), and the tendon reflexes of both lower limbs (++). The patient was also given electrocardiogram, blood routine and other preoperative tests, and there were no abnormal manifestations. The patient was given a cranial MRI-enhanced CT examination, which showed brain tissue swelling, significant dural enhancement, and abnormal signals in the supratentorial brain tissue, suggesting the possible existence of meningoencephalitis. In addition, a lumbar puncture showed human herpes virus type I, elevated leukocytes and intracranial pressure, which, combined with the patient’s clinical symptoms, led to the diagnosis of herpes simplex viral encephalitis. After obtaining a specific diagnosis, the patient was given symptomatic and allopathic treatment. Symptomatic treatment consisted of antiepileptic drugs, such as sodium valproate tablets, and active cranial pressure lowering treatment, such as the application of mannitol injection, for the patient’s convulsion symptoms. And the allopathic treatment is mainly the application of injectable ganciclovir, injectable ceftriaxone, etc., and active antiviral treatment.
III. Treatment effect
After 10 days of treatment, the patient’s symptoms of nausea, vomiting and headache improved, but he still had speech and cognitive impairment and could not take care of himself. At 20 days of treatment, the patient’s nausea, vomiting, headache and other symptoms disappeared, and the speech and cognitive impairment had recovered.
Since the patient had speech and movement disorders at the time of discharge, the patient’s family was reassured and told that the patient’s symptoms would gradually recover with professional rehabilitation training and that there was no need to worry too much. In addition, the patient should be brought to the follow-up clinic every month for slow discontinuation of medication according to the recovery situation. If other uncomfortable symptoms appear during the recovery process or if the existing symptoms worsen, the patient should come to the clinic immediately.
IV. Notes
We are glad that after a series of treatments, the patient’s symptoms of nausea, vomiting and headache have improved and he was discharged successfully for subsequent rehabilitation. However, since the patient was not completely cured at the time of discharge and still had speech and activity disorders, etc., the following points still need to be noted in life.
1, the patient needs to be bedridden for a long time due to unconsciousness, so the family needs to pay close attention to the changes in the patient’s condition, and also needs to give the patient turning and back rubbing on time to keep the skin clean, and give leg massage regularly to promote blood circulation and prevent the emergence of blood clots, etc.
2, patients still need to strictly follow the doctor’s instructions for regular medication after discharge, avoid stopping or reducing the dosage on their own to prevent recurrence of the disease.
3. Patients need to pay attention to a light and easily digestible diet, including porridge, noodles and other light and easily digestible food, and increase the intake of fruits, vegetables and high quality protein, and avoid stimulating food to ensure balanced nutrition.
V. Personal Insights
Herpes simplex virus encephalitis is relatively common and is mostly caused by viral infection. There may be precipitating factors such as cold and exertion, and prodromal symptoms such as fever and headache may occur, and some people may not have prodromal symptoms. If herpes simplex encephalitis is suspected, it is also necessary to combine this with ancillary tests such as cranial MRI and cerebrospinal fluid to identify the specific causative agent.
Herpes simplex virus encephalitis is a serious condition, so it needs to be taken seriously. In this case, the patient was seen in time, but the specific cause of the disease was not clarified and led to an aggravation of the disease, which was treated well but easily left some sequelae, which may affect the patient’s normal life in the future and may lead to death in severe cases. Therefore, once similar symptoms appear in the life of the general public, do not delay, should go to the regular hospital in time to clarify the specific cause and give timely treatment.