Acute herpes simplex virus encephalitis

[Outlined]
Herpes virus infection of the brain inflammatory responses, the majority of cases by the herpes simplex virus type 1 due.
[Diagnosis]
First, history and symptoms:
Acute onset, High fever, headache, vomiting, and myoclonic seizures, with most of disturbance of consciousness, rapid weight to enter deep coma. Some of the first to mental disorder, slack performance, speech movements reduced, unresponsive or emotional anxiety, incoherent speech, memory, disorientation, or even a wrong perception, hallucinations, paranoia and strange behavior may arise delirium.
Second, the medical examination found:
Some patients in your lips with herpes. Diversity was nervous system symptoms, commonly have hemiplegia, aphasia, with the skewed eyes, involuntary movement. Some were to cortical brain tonic or to the state as fundus examination showed papillary edema; stiff neck, meningeal irritation positive eyelid ptosis, not on pupil size.
Third, ancillary inspection:
1. Cerebrospinal fluid pressure increased leukocyte count and protein increased to lymphocyte predominance, we can see that large number of red blood cells, sugar, chloride normal.
2. EEG that the resulting chronic slow wave amplitude, temporal more obvious, and there are sharp cyclical high-amplitude wave.
3. Brain CT brain can be found in low-density lesion, common in unilateral or bilateral temporal lobe.
4. Virology inspection: double CSF herpes simplex virus antibody titration degrees by as much as four times more than single-CSF in the antibody titers> one eighty; a single serum / CSF antibody titer ≤ 40, and serum antibody or complement combination antibody titer gradually to 4 times more.
4. Identification:
Need and brain tumor, brain abscess, and other viral encephalitis differential.
[Treatment]
First, anti-virus treatment: preferred acyclovir, each 10 mg / kg dissolved in 100 ml solution within 1-2 hours after infusion, once every 8 h, 10 days for a course of treatment.
Second, large dose hormone (hydrocortisone 100-500 mg / d or dexamethasone 10-20 mg / d) and 20% mannitol infusion decreased intracranial pressure and reduce cerebral edema and, if necessary, under the temporalis muscle decompression surgery.
Third, high fever, convulsions, mental disorder, irritability, physical cooling should be given, only convulsion, sedative treatment.
4, coma, respiratory patency should be noted, the water and electrolyte balance, maintaining nutrition, oral cleaning to prevent bed sores, urinary tract infections and lung. Can small dose of blood transfusion, or human serum albumin compound amino acid, etc..
V. Application of interferon, transfer factor and immune globulin to enhance immunity.
6. Recovery can be physiotherapy, massage, acupuncture and other help restore limb function.