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    重症病毒性脑炎合并超难治性癫痫持续状态

    Clinical analysis of 11 cases of severe acute viral encephalitis combined with Super-Refractory Status Epilepticus

    • 摘要: 目的 探讨急性重症病毒性脑炎合并超难治性癫痫持续状态(SRSE)临床特点和诊治经验。方法 回顾性分析院神经内科近4年收治的重症病毒性脑炎合并SRSE患者的临床资料,随访患者病情转归。结果 男6例,女5例,年龄17-71岁。所有患者均有前驱病史,发病后0-8天出现癫痫发作。10例患者行持续床边视频脑电检测,均显示癫痫持续状态。,轻度异常10例脑脊液压力升高6例病毒检测阳性2例。头颅CT或MRI有异常信号4例表现为弥漫性脑水肿2例,额颞叶异常信号2例。9例患者行血液及脑脊液自身免疫性脑炎系列抗体检测,8例阴性,1例阳性。11例患者均接受四种或以上抗癫痫药物病程中10例患者行气管插管,其中5例行气管切开治疗。11例患者经治疗好转9例,放弃治疗1例,死亡1例。结论下,。

       

      Abstract: Objective To investigate the clinical characteristics, diagnosis and the treatment of severe acute viral encephalitis combined with Super-Refractory Status Epilepticus(SRSE). Methods The clinic files of 11 cases in our hospital were analyzed retrospective during the four years from September 2013 to June 2017. We had followed up the family member of these patients with the development of the disease process and the prognosis of disease. Results There were 6 males and 5 females with ages ranging from 17 to 71 years. All the patients had a history of prodromal infection, and seizures occurred within 0-8 days after the onset of the disease .10 patients underwent continuous video electroencephalogram (VEEG) examination, all results showed status epilepticus. Cerebrospinal fluid tests showed normal in one cases, while mild anomaly in 10 cases. Cerebrospinal fluid pressure increased in 6 cases, and virus detection was positive in 2 cases. Abnormal signals of brain CT or MRI were found in 4 cases. 2 cases showed diffuse cerebral edema and 2 cases showed frontotemporal abnormal signal. 9 cases of blood and cerebrospinal fluid autoimmune encephalitis antibody were detected, which demonstrated 8 cases of negative, and 1 cases of positive. All 11 patients received four or more antiepileptic drugs combined with two intravenous anesthetics and immunosuppressive agents treatment. During the course of the disease, 10 patients underwent endotracheal intubation, 5 of whom underwent tracheotomy. After the treatment, results showed that 9 cases had improvement, 1 case gave up treatment, and 1 case died. Conclusion Under VEEG monitoring, flexible intravenous anesthetics combined with adequate antiepileptic drugs and immunosuppressive agents are effective in the treatment of severe viral encephalitis combined with SRSE, and patients who received NICU specialist treatment can reduce mortality

       

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