精神分裂症合并1型单纯疱疹病毒性脑炎个案报道及文献复习

Case Report and Literature Review of Schizophrenia Complicated with Herpes Simplex Virus Encephalitis Type 1

摘要: 单纯疱疹病毒性脑炎是病毒直接侵犯脑组织所致的中枢神经系统感染性疾病，病变脑组织可出现水肿、坏死、软化等改变。病毒通过嗅神经或三叉神经选择性侵犯额颞叶等部位，引起一系列的临床表现。弥漫性脑损害时，更易引起精神病样症状。约1/3~1/2病例以精神障碍为首发或唯一症状，早期易误诊为其他精神疾病。该病例病史长达几十年，突然出现精神行为异常加重，且伴有意识改变，在外院长期诊断为“精神分裂症”，病情变化前规律服用抗精神病类药物治疗，入院后完善腰椎穿刺获取脑脊液送检，最后经基因检测证实为HSE 1型感染，明确诊断精神分裂症合并1型单纯疱疹病毒性脑炎。

Abstract: Herpes simplex encephalitis is an infectious disease of the central nervous system caused by direct viral invasion of brain tissue, resulting in pathological changes such as edema, necrosis, and soften-ing. The virus selectively invades the frontotemporal lobe through the olfactory or trigeminal nerve pathways, leading to a range of clinical manifestations. Diffuse brain damage is more likely to mani-fest as psychotic symptoms. Approximately 1/3 to 1/2 of cases present with mental disorders as either the initial or sole symptom, often leading to early misdiagnosis as other psychiatric condi-tions. In this particular case, the patient’s abnormal mental behavior suddenly deteriorated, ac-companied by alterations in consciousness, and was previously diagnosed as “schizophrenia” in other medical facilities. Prior to the change in condition, the patient had been regularly taking an-tipsychotic medication and underwent a lumbar puncture to obtain cerebrospinal fluid after ad-mission, which ultimately confirmed herpes simplex virus encephalitis type 1 (HSE-1) infection through genetic testing and established a diagnosis of schizophrenia complicated by HSE-1 infec-tion.