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Clinical Observation of Encephalitis Empasizing the Clinically Suspected Herpes Encephalitis Cases.

Journal of the Korean Pediatric Society 1990;33(5):615-622.
Published online May 31, 1990.
Clinical Observation of Encephalitis Empasizing the Clinically Suspected Herpes Encephalitis Cases.
Young Sook Lee, Young Don Lee, Yong Seung Hwang
Department of Pediatrics, Seoul National University, College of Medicine Seoul, Korea
뇌염 (Encephalitis) 에 대한 임상적 관찰 — 임상적으로 포진성 뇌염 (Herpes Encephalitis) 이 의심된 예를 강조하며 —
이영숙, 이영돈, 황용승
서울대학교 의과대학 소아과학교실
Received: 10 November 1989   • Accepted: 21 December 1989
The prognosis in all encephalitis is guarded with respect to both immediate outcome and sequelae. But, in fact, there is no specific treatment agent for encephatitis except herpes encephalitis which is almost fatal without adequate treatment. Acyclovir(9- [2-hydroxyethoxymetry] -guanine) has proved to be a safe and effective agent for therapy of early stage of herpes simplex virus infections. So, in herpes encephalitis, early diagnosis is essential for an adequate outcome, and, therefore, a high index of clinical suspicion is imperative. In this study, clinical observation of 36 cases of encephalitis(from Oct. 1985 to June 1989) emphasiz- ing the clinically suspected herpes encephalitis was done in the Department of Pediatrics, Seoul National University Hospital. The results were summarized as follows; 1) The incidence of encephalitis for 3 8/12 yrs was 0.3% (36 cases) and that of herpes encephalitis 0.04% (5 cases) 13.9% of all encephalitis. 2) There were no significant differences in age and sex distritution, seasonal incidence and CSF findings between overall encephalitis and herpes encephalitis. 3) Regarding the clinical symptoms and signs, encephalitis showed fever in 97.2%, mental change in 86.1%, neck stiffness in 50% and seizures in 44%, while herpes encephalitis showed fever, seizure, mental change in 100% and hemiplegia in 40%. The seizures associated with herpes encephalitis were partial seizures. 4) The EEG findings showed focal slowings in 29.2%, focal epileptiform in 25% and normal findings in 20.8% diffuse slowings in 16.7% of encephalitis patients, while PLEDs in 40%, focal epileptiform in 40% and asymmetry in 40% of herpes encephalitis patients revealing more lateralized or focal abnormal findings. 5) The brain CT findings showed normal in 48.1%, focal low density in 29.6% and diffuse swelling in 11.1%, while focal low density in frontal or temproal lobe in 80% and focal hemorrhage in 20% and ventricular dilatation in 20% of herpes encephalitis. 6) Symptomatic and supportive treatment for encephalitis resulted in imporved state in 87.5% of patients, stationary in 12.5% and expired in 3%. Acyclovir therapy was tried for 4 patients among 5 herpes encephalitis patients. Three patients showed clinical imporvement with the therapy. Two patients including one without acyclovir therapy discharged against medical advise.
Key Words: Encephalitis, Herpes encephalitis

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