■自2018年首次报告致命的博尔纳病毒-1(BoDV-1)脑炎以来,病例逐渐增加。缺乏诊断算法,到目前为止还没有有效的治疗方法。
我们报告了一名77岁女性的急性BoDV-1脑炎,患有流感样发作,快速发展到单词发现困难,人格改变,全球迷失方向,弥漫性认知缓慢,步态共济失调和进一步恶化与发烧,威胁主义,严重的低钠血症,癫痫发作,认知能力下降,和局灶性皮质和小脑症状/体征。广泛的诊断检查(脑血管液体,血清,和MRI)的(脑膜-)脑炎在已知原因下呈阴性。我们的经验常见的抗病毒药物,抗菌,免疫抑制治疗失败。患者入院5天后昏迷,在第18天失去所有脑干反射,此后仍完全依赖有创机械通气,并在第42天死亡.大脑和脊髓尸检证实了广泛的,弥漫,严重的非化脓性,由于BoDV-1引起的淋巴细胞硬化性全脑脊髓炎,影响新皮质,皮质下,小脑,神经垂体,和脊髓区域。连同我们的案子,我们严格审查了所有报告的BoDV-1脑炎病例.
■急性BoDV-1脑炎的诊断具有挑战性和延迟,当它发展到致命的时候。在这项研究中,我们列出了迄今为止所有尝试过的和失败的治疗方法,以供将来参考,并提出了一种诊断算法,用于及时怀疑和诊断.
UNASSIGNED: Since the first report of fatal Borna virus-1 (BoDV-1) encephalitis in 2018, cases gradually increased. There is a lack of diagnostic algorithm, and there is no effective treatment so far.
UNASSIGNED: We report an acute BoDV-1 encephalitis in a 77-year-old female with flu-like onset, rapid progression to word-finding difficulties, personality changes, global disorientation, diffuse cognitive slowness, and gait ataxia and further deterioration with fever, meningism, severe hyponatremia, epileptic seizures, cognitive decline, and focal cortical and cerebellar symptoms/signs. The extensive diagnostic workup (cerebrovascular fluid, serum, and MRI) for (meningo-)encephalitis was negative for known causes. Our empirical common antiviral, antimicrobial, and immunosuppressive treatment efforts failed. The patient fell into coma 5 days after admission, lost all brainstem reflexes on day 18, remained fully dependent on invasive mechanical ventilation thereafter and died on day 42. Brain and spinal cord autopsy confirmed an extensive, diffuse, and severe non-purulent, lymphocytic sclerosing panencephalomyelitis due to BoDV-1, affecting neocortical, subcortical, cerebellar, neurohypophysis, and spinal cord areas. Along with our
case, we critically reviewed all reported BoDV-1 encephalitis cases.
UNASSIGNED: The diagnosis of acute BoDV-1 encephalitis is challenging and delayed, while it progresses to fatal. In this study, we list all tried and failed treatments so far for future reference and propose a diagnostic algorithm for prompt suspicion and diagnosis.