儿童伴胼胝体压部可逆性病变的轻度脑炎/脑病患者的临床特征分析

摘要

目的 探讨儿童伴胼胝体压部可逆性病变的轻度脑炎/脑病(MERS)患者的临床及影像学特点.方法 对我院2013-2014年诊治的4例MERS患儿的临床资料进行回顾性分析,包括临床表现、神经系统异常体征、实验室检查、磁共振头部平扫(1.5 T)以及治疗和预后情况,并对相关文献进行复习.结果 4例患儿以消化道(3例)或呼吸道(1例)症状起病,以意识障碍(嗜睡3例、昏睡1例)、抽搐(4例)、头痛(1例)为主要症状,神经系统异常体征包括:颈项强直阳性(3例),双侧巴宾斯基征阳性(3例),双侧球结膜水肿(2例).实验室检查:血钠平均131.6 mmol/L,1例脑脊液常规生化异常.病原学检查:2例大便人轮状病毒抗原阳性,2例肺炎支原体抗体阳性.头颅MRI:仅见胼胝体压部可逆性异常信号(斑片状T1WI等或低信号,T2 WI稍高信号,FLAIR稍高信号,DWI高信号,表观弥散系数低信号,边界清晰).常规治疗基础上,加用地塞米松(4例)及丙种球蛋白(3例),1周内临床症状消失,2周内头颅MRI病灶消失.结论 MERS是一种临床-影像学综合征,常急性起病,临床症状轻微,头颅MRI有特征性改变,预后良好.%Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum (MERS) in children.Methods Four patients of MERS, who were diagnosed and treated in the First Hospital of Jilin University during 2013-2014, were collected retrospectively.Their clinical, laboratory, radiologic data and the related literatures were reviewed.Results Four patients onsetted as gastrointestinal symptom (3 cases) or respiratory (1 case) symptom, in accompany with disturbance of consciousness (3 cases of drowsiness, 1 case of lethargy), convulsions (4 cases), headache (1 case) as the main symptoms.Abnormal neurological signs included positive cervical resistance (3 cases), positive bilateral Babinski sign (3 cases), bilateral chemosis (2 cases).Laboratory test showed the average blood sodium was 131.6 mmol/L, while the cerebrospinal fluid test only showed abnormality in 1 case.In etiology examination, 2 cases showed human rotavirus antigen positive, and Mycoplasma pneumoniae antibody was found positive in 2 cases.Cranial MRI showed reversible lesion in the splenium of corpus callosum (patchy iso-or hypo-intensity on T1 WI and apparent diffusion coefficient, hyper-intensity on T2WI, FLAIR and DWI, clear boundary).After active treatment, clinical symptoms disappeared within 1 week, and cranial MRI lesions disappeared within 2 weeks.Conclusion The clinical presentations of MERS, which is a clinical-radiological syndrome, are sudden onset and mild, with characteristic changes in brain MRI and good prognosis.