Pribarin causes trouble, don't "strip herpes-related encephalitis" back pot!

First, the case introductionpatient is an elderly woman, due to consciousness disorder 1 turnover to my hospital emergency, before the history of facial shingles, so the local hospital proposed for herpes encephalitis, antiviral treatment and did not improveherpes is an acute inflammatory skin disease caused by the chickenpox shingles virus, the main feature of which is cluster-cluster herpes walking along the surrounding nerves, accompanied by significant nerve painface is more often affected by the trigeminal nerve, of which the first trigeminal nerve is most commonly affected, distributed on one side of the forehead face, serious lying can invade the cornea leading to blindnessthe virus's initialinfectionis shown as chickenpox, the virus can be long-term lurking in the nerve section, when theimmuneweakened function can induce chickenpox shingles virus can re-act, along the surrounding nerves and skin band herpespatients are sleepy when they transfer to the wardin the afternoon, strong wake-up can answer:positioning can, know people in Huashan Hospital; The patient whites their eyes and says angrily, "I don't know!", asked her in the morning afternoon, she said that she had eaten two meals today, the people present did not respond for a momentpatients with good memory and numerals, the left face saw shingles, which met the distribution range of the first and second trigeminal nerves (Figure 1)Figure 1Patients trigeminal nerve first and second affected, white powder for furnace glycoshi wash patients left corneal reflection is weaker than the right side, neck soft, Gram negative, Pasteur negative, limb muscle tone is low, tendon reflection is weak, muscle force 3 levels, may be due to non-cooperation patients have been hospitalized outside for a week, the external hospital check electroencephalogram normal, normal magnetic resonance, waist through cerebrospinal fluid cell 26x.106/L, biochemical normal I asked the bed doctor what to think about She answered the encephalitis; She replied that the patient had herpes and that the waist was high , shingles-related encephalitis
chickenpox and shingles as the same virus the of infection, chickenpox stage has about 0.01% to 0.25% of patients with neurological symptoms the shingles stage is more than the chickenpox stage of neurological complications, such as the infamous herpes after nerve pain, other including cranial nerve paralysis, motor nerve damage, myelitis, encephalitis, cerebral vascular disease, acute rising neurogenic neuroitis and sterile meningitis shingles encephalitis is less common, only 0.1% to 0.2% of people infected with the virus, then what kind of patients are prone to concurrent encephalitis? have immunodeficiency , have diabetes , herpes is widely distributed, trigeminal nerve seiswells, repeated shingles encephalitis usually occurs days to weeks after herpes, sometimes several months apart, and in a few cases can occur before herpes or without herpes Chamizo FJ and others studied 26 cases of shingles virus affecting the central nervous system, showing meningitis in 46.2%, meningo encephalitis 53.8% T.De Brouckera and others studied 20 cases of shingles encephalitis, with the most symptoms being fever (90%), confusion (70%), dyslexia (70%), meninges irritation (60%), teriose signs (55%) and indifference (50%) waist cerebrospinal fluid has a general mild increase in nuclear cells, an average of 150x.106/ml, mainly lymphocytes, protein average 0.99 g/L, glucose levels are usually normal The diagnosis of the disease is usually based on clinical performance: 1 shingles; 2 the sequence of rashes and encephalitis "Isn't it strange that patients are so cold and humorous?" I asked bed doctors think yes, the usually dyslexia of encephalitis is rarely cognitively intact " or meningitis? "
" no headache or fever "
-bed doctor suddenly slurped the patient had a long time ago with shingles, 2 weeks ago typhoon Litchma scraped the patient's place of residence, after the storm flooded the Dragon Temple, the patient was frightened after the recurrence of old disease, left face herpes pain, 1 week ago the flood retreated, so the patient To the local hospital, when admitted to the hospital
diagnosis for shingles, when people are very clear, and on the third day was unconscious, the family said that it was serious enough to call also can not wake up, size two is not self-aware, even diapers are used EEG and mrion were done at that time, when the EEG showed that the alpha rhythm was intact, the adjustment amplitude was normal (Figure 2), and the skull MRI and MRA did not see any particular abnormalities (Figure 3) I said there must be something wrong with this, and the bed doctor must dig deep into the medical history Figure 2 The EEG is normal, the background is alpha rhythm, and the patient has a conscious disorder at the time of the description Figure 3 The head MRI and MRA are basically normal
three, the encephalogram and magnetic resonance performance of herpes-related encephalitis
most patients with shingles-related encephalitis will behave abnormally, Shi Jinrong and other reported in 11 patients 9 cases of abnormal encephalogram, mainly manifested as diffuse slow waves Peterslund and others reported 4 of the five patients with slow wave performance T.De Brouckera counted 14 cases of encephalitis, of which 13 showed diffuse slow waves, 4 had slow waves of the temporal lobe, and 2 were exhibiting eclampsia-like discharges shingles virus prone to invasion of vascular , Nagel MA and other review edified 23 cases of vascular damage patients, angiography 70% of the existence of abnormal, large and large blood vessels widely affected accounted for 50%, small blood vessels affected by 37%, alone large blood vessels affected 13% the related lesions seen by MRI can therefore be broadly divided into vascular and non-vascular damage, vascular damage includes asymptomatic vasculatence, vasculitis, cerebral infarction and cerebral hemorrhage (Figure 4); But 35% of patients had a normal magnetic resonance Figure 4 Vascular damage caused by herpes virus Figure 5 Non-vascular damage caused by herpes virus
so auxiliary examination does not prove that the brain is sick, you might say that there are still 26x.106/L white blood cells in the cerebrospinal fluid? According to Skripuletz T and other studies, 18% of patients with trigeminal neurocytosis, 80% of backroot neuromethertitis and 63% of facial paraplegia can have mild cerebrospinal fluid cell increases, so a few white blood cells alone cannot be judged to be encephalitis what would that be? This patient is a decline in consciousness, not cognitive decline, and in my opinion, she is more like asleep, so be alert to metabolic or toxic encephalopathy, I asked the bed doctor to continue digging deep after such a little dial, the bed doctor did ask the important situation A week ago the patient was hospitalized with severe facial shingles pain, the first day of admission to Primain 75mg tid po, to the third day of the occurrence of consciousness disorder, is the front diaper section, and the consciousness disorder is not persistent, after about 6 hours the patient woke up some, so the patient's family transferred her to a higher hospital hospital, went to the emergency according to the brain Inflammatory treatment, so also did not bother to use Pribarin, the next two days people's consciousness improved a little bit, but a sober old lady shouted pain, and then put Primbarin (75mg bid po) back, it took two days for the patient to fall asleep again, so they sent her to my hospital emergency, and until the patient in my hospital emergency patient is still taking Primbarin 3, it turned out that Pribarin was a scourge Priebain did have side effects of drowsiness and consciousness disorders, but the incidence was extremely low, with a rate of drowsiness of only 12 per cent at 150mg/d and 18 per cent at 300mg/d, while those with a lower awareness disorder were 2 per cent at 150mg/d and 3 per cent at 300mg/d Kato H and other 204 patients who took Primbarin had two risk factors for dizziness and drowsiness in the first week of taking the drug: taking opiates (OR:5.507) and older than 65 years (OR: 2.507) Napribarin dare not use it anymore? In fact, to be fair, drugs used to treat nerve pain, such as carmasilin, phenytoin, gabapentin and bachlorofen, all have similar side effects, and many types of drowsiness rates are much higher than primalic Primin as a new generation of nerve pain treatment drugs, its efficiency and safety are better, Li Yinhua reported that Primin treatment pain
diabetes neuropathy effect is the most significant; we told the patient's family to stop using Pribarin, after a night the patient's spirit is much better, we gave the patient some hydrochloric acid namefin wake up, to the third day, the patient's mind completely returned to normal, and then the patient herpes began to pain again, but given the patient's special physique, we did not give him any more nerve pain medication, Pribarin is still so, then other drugs are not more vulnerable? It's better to be in pain than to pass out The patient later had an Electroencephalogram and an mrion of the skull, and everything was still fine postscript: I guess a lot of people didn't expect this to end, shingles - encephalitis, tummy - Greenberry, teratoma - autoimmune encephalitis, thymus tumor - severe muscle weakness, atrial fibrillation - cerebral embolism .. Let's think of these logical combinations, when we " its valley and get its axe", is it a bit of "action attitude, no like the ax-stealer" feeling? Is also the suspect neighbor to steal the axe also Zhang Yue Source: Zhang Yue's Public