Encephalitis caused by herpes simplex virus infection is an inflammatory reaction of the brain parenchyma, with most cases resulting from herpes simplex virus type I.

bubble_chart Diagnosis

1. Medical History and Symptoms:

Acute onset, high fever, headache, vomiting, myoclonus, and epileptic seizures, mostly accompanied by consciousness disorders, with severe cases rapidly progressing to deep unconsciousness. Some patients initially present with mental confusion, manifesting as dullness, reduced speech and movement, slow reactions or agitation, incoherent speech, memory and orientation disorders, and even illusions, hallucinations, delusions, and bizarre behaviors. Delirium may also occur.

2. Physical Examination Findings:

Some patients exhibit herpes on the lips. Neurological symptoms are diverse, commonly including hemiplegia, aphasia, conjugate gaze deviation, and involuntary movements. Some may show decerebrate rigidity or decorticate posturing. Fundus examination may reveal optic disc edema; neck stiffness and positive meningeal irritation signs are present. Ptosis and unequal pupil size may also be observed.

3. Auxiliary Examinations:

1. Increased cerebrospinal fluid (CSF) pressure, elevated white blood cell count and protein levels (predominantly lymphocytes), and the presence of numerous red blood cells, with normal glucose and chloride levels.

2. Electroencephalogram (EEG) may show diffuse high-amplitude slow waves, more prominent in the temporal regions, and periodic high-amplitude sharp waves.

3. Cranial CT may reveal low-density lesions, commonly in one or both temporal lobes.

4. Virological tests: A fourfold or greater increase in herpes simplex virus antibody titers in paired CSF samples; a single CSF sample with antibody titer >1:80; a serum/CSF antibody titer ratio ≤40; or a gradual fourfold or greater increase in serum neutralizing or complement-fixing antibody titers.

Differentiation is required from brain tumors, brain abscesses, and other viral encephalitides.

bubble_chart Treatment Measures

1. Antiviral therapy: Acyclovir is the first choice, administered at 10mg/kg each time, dissolved in 100ml solution and intravenously infused over 1-2 hours, every 8 hours, for a course of 10 days.

2. High-dose hormones (hydrocortisone 100-500mg/day or dexamethasone 10-20mg/day) and 20% mannitol intravenous infusion to reduce intracranial pressure and alleviate cerebral edema. Temporal muscle decompression surgery may be performed if necessary.

3. For patients with high fever, spasms, mental confusion, or restlessness, physical cooling, antispasmodic treatment, and sedation should be provided.

4. For unconscious patients, ensure airway patency, maintain water and electrolyte balance, provide adequate nutrition, keep the oral cavity clean, and prevent bedsores, pulmonary, and urinary tract infections. Small-dose blood transfusions, human albumin, or compound amino acids may be administered.

5. Use interferon, transfer factor, and immunoglobulin to enhance immunity.

6. During the convalescence stage, physiotherapy, tuina, acupuncture, and other methods can be employed to aid in the recovery of limb function.