Analysis of clinical outcome and treatment of viral encephalitis with bilateral thalamic damage / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the clinical outcome and treatment characteristics of viral encephalitis with bilateral thalamic damage so as to improve its prognosis.Methods Twelve cases of viral encephalitis with bilateral thalamic damage were collected during September 2012 to June 2013 by head MRI.These cases were retrospectively studied with the data of medical history,physical examination,laboratory and brain function monitoring and treatment.The relationship between treatment and prognosis was studied during 2 years of follow-up.Results All patients began with the rapid onset,accompanied by fever,coma,and convulsions.Delirium and involuntary movement occurred during the recovery period.Six cases(50.0％) received ventilator assisted ventilation.In the acute phase,electroencephalogram (EEG) showed diffuse slow wave and 4 cases(33.3％) had status epilepticus on EEG.Ten cases discharged from hospital had long-term oral anti epileptic drugs,which lasted 6 months in 3 cases,1 year in 4 cases,and 2 years in 3 cases for maintaining EEG stability.Head MRI indicated white matter demyelination besides the gray matter damage within the thalamus.All 12 patients underwent methylprednisolone impact treatment and 6 cases had effective reversal within 1 week of onset with better tolerance,and the other 6 cases received treatment in subacute stage and 5 of them accelerated recovery and 1 case had sense improvement,but died after giving up therapy.After 3 months courses,8 cases(66.7％) got gross motor and swallowing function recovered to normal,and 3 cases had left unilateral limb movement disorder.After 2 years of follow-up,11 cases had normal motor,intelligence returned to normal in 9 cases,and 2 cases had mild mental retardation.Conclusions Viral encephalitis complicated with bilateral thalamic damage is characterized by acute onset,serious manifestations,idiopathic progress;in the subacute stage it is most likely to develop white matter demyelination.The key to control the disease is to block the inflammatory immune response quickly,and give patients large dose methylprednisolone treatment can effectively curb the progress of the disease.In the sub acute phase,it can promote the recovery,safe and effective.The long-term prognosis will be good with the reasonable treatment at early stage of the disease.