以精神症状为首发的病毒性脑炎50例临床分析

摘要

目的 探讨以精神症状为首发和突出表现的病毒性脑炎患者的临床特征,提高对该病的认识,减少误诊与漏诊.方法 对50例以精神症状为首发的病毒性脑炎患者临床资料进行回顾性分析.结果 50例患者中幻觉妄想综合征占68％；情绪低落或淡漠等类抑郁综合征占26％；冲动、易激惹行为占22％；意志行为障碍者占6％,伴有不同程度意识障碍者占30％,伴有癫痫发作者占72％,伴认知功能障碍者占84％,伴语言障碍者占10％,伴有运动功能障碍者占8％.不同病毒IgM(+)者占12％,脑脊液(CSF)检查:压力＞200mmH2O者占4％,白细胞数增高者占16％,蛋白定量增高者占20％,脑电图检查有46％的患者表现为中-重度异常,影像学检查有26％异常,其中18％表现为皮层、皮层下异常信号,8％表现为海马、颞叶内侧异常信号,1例(2％)脑膜增厚,3例(6％)脑萎缩；经过抗病毒、营养神经、抗癫痫、抗精神症状等对症支持治疗,96％的患者精神症状均得到控制.结论 以精神症状为主要表现的病毒性脑炎临床表现多样、复杂,容易误诊、漏诊,要注意与非惊厥性癫痫、功能性精神病鉴别.%Objective To investigate the clinical characteristics of viral encephalitis patients with psychiatric symptoms as initial and prominent performance,to deepen the understanding of the disease,reduce misdiagnosis and missed diagnosis.Methods Fifty patients with psychiatric symptoms as initial and prominent performance were retrospectively analyzed.Results Fifty cases of delusional syndrome accounted for 68％ ; Depressed mood or indifferent and depressive syndrome accounted for 26％ ; impulse,irritable behavior 22％ ; Volitional behavior disorder accounted for 6％,with varying degrees of disturbance of consciousness accounted for 30％ ;with seizures accounted for 72 ％ and cognitive dysfunction,accounted for 84％,with language disorder associated with motor dysfunction accounted for 10％,accounted for 8％.Different virus IgM (+) accounted for 12％,pressure of cerebrospinal fluid (CSF)≥ 200mmH2O was 4％,increased white blood cell was 16％,increased protein accounted for 20％.46％ of the patients showed moderate and severe abnormal in EEG.Abnormal Imaging accounted for 26％,with 18％ in abnormal signal in cortical and subcortical,8％ in hippocampus and medial temporal lobe,which were abnormal signal.1 cases (2％) meningeal thickening,3 cases (6％)of brain atrophy.after antiviral,anti-epilepsy,control mental symptom and supportive treatment,96％ patients with mental symptoms were controlled.Conclusion The clinical manifestations of viral encephalitis with mental symptoms as the main performance of the diversity,complexity,easy misdiagnosis,missed diagnosis,must pay attention to non-convulsive seizures or functional mental disease identification.