Characteristics and Misdiagnosis of Viral Encephalitis Manifested by Isolated Dizziness in 37 Cases
10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.2025.0120
- VernacularTitle:37例以孤立性头昏为表现的病毒性脑炎特点和误诊分析
- Author:
Xiangxue ZHOU
1
;
Wei ZHONG
2
;
Shaohua XU
1
Author Information
1. Department of Neurology， The First Affiliated Hospital of Sun Yat-sen University // Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases // National Key Clinical Specialty and National Key Discipline， Guangzhou 510080， China
2. Clinical Laboratory， East Division， The First Affiliated Hospital of Sun Yat-sen University， Guangzhou 510700， China
- Publication Type:Journal Article
- Keywords:
cerebrospinal fluid cytology;
vestibular function;
viral encephalitis;
giddy;
diagnostic efficiency
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2025;46(1):172-178
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo study the clinical features of viral encephalitis with isolated dizziness，and to analyze the diagnostic efficacy of vestibular function examination and cerebrospinal fluid cytology in these patients. MethodsTotally 37 cases of viral encephalitis with isolated dizziness and 10 healthy volunteers were included. Clinical data ［dizziness handicap inventory （DHI） score，head imaging，electroencephalogram，vestibular function test，cerebrospinal fluid routine，biochemistry，cell morphology，etiology second-generation sequencing，misdiagnosis］ were collected. The area under the ROC curve（AUC）of diagnostic value of each type of test was analyzed. The changes of each examination before and after treatment were compared. ResultsWe found 89.19%（33/37）of the patients were misdiagnosed. Vestibular function smooth follow-up test indicated vestibular central lesion （AUC value：0.82）in 64.86%（24/37）of the patients. The number of CSF transformed lymphocytes increased in 86.49%（32/37）of the patients（AUC value：0.93），the CSF large lymphocytes increased in 97.30% （36/37）of the patients （AUC value：0.99），and the mononucleosis was activated in 94.59%（35/37）of the patients（AUC value：0.97）. Furthermore，18.92%（7/37）of the patients had increased EEG slow wave（AUC value：0.60），while 13.51%（5/37） of the patients showed cortical swelling on head MR （AUC：0.60）. After antiviral treatment，dizziness grade decreased（Z=-4.899，P<0.001），smooth tracking abnormalities decreased（Z=-4.583，P<0.001），the proportion of CSF transformed lymphocytes decreased（t=4.281，P<0.001），and the proportion of large lymphocytes decreased（t=6.905，P<0.001）. ConclusionThe misdiagnosis rate of viral encephalitis with isolated dizziness is high. Incorporating into diagnosis the increased large lymphocytes， transformed lymphocytes，activated monocytes in CSF cytology with smooth follow-up test may improve diagnostic efficiency .
