儿童肺炎支原体感染相关伴可逆性胼胝体压部病变的轻微脑炎/脑病临床及影像学特点

摘要

目的 探讨儿童肺炎支原体感染相关伴可逆性胼胝体压部病变的轻微脑炎/脑病(MERS)的临床及影像学特点.方法 回顾性分析本院诊断的15例MERS患儿的临床资料进行总结分析.结果 15例患儿中,男5例,女10例,发病年龄2岁1月至11岁,15例患儿均为急性感染起病,8例以呕吐、腹泻等消化道症状起病,2例以咳嗽等呼吸道感染症状起病,8例伴有发热症状,15例伴有抽搐症状,2例病初伴意识障碍,均表现为嗜睡.15例患儿均行腰椎穿刺检查,脑脊液常规生化等均在正常范围.13例患儿脑电图检查异常,表现为各导联慢活动增多.起病4～6d行头颅MRI检查提示胼胝体压部病变,表现为DWI序列高信号.15例患儿病原学检查均提示肺炎支原体(MP)-IgM或-Ab阳性.10例患儿7～12d后复查头颅MRI胼胝体压部病变完全恢复正常.15例患儿入院后均予以抗感染并口服阿奇霉素治疗,未予丙球及激素治疗,住院4～14 d后出院,10例患儿间隔7～12d复查头颅MRI均恢复正常.结论 儿童肺炎支原体感染相关伴可逆性胼胝体压部病变的轻微脑炎/脑病,临床症状表现为轻微脑炎或脑病症状,影像学胼胝体压部病变具有可逆性,预后良好.%Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children with mycoplasmmapneumonia infection.Methods The clinical data of 15 children with MERS diagnosed in our hospital were analyzed retrospectively.Results Among the 15 cases,there were 5 males and 10 females.The onset age ranged from 2 years old to 11 years old.All the 15 cases were onset of acute infection.8 cases were onset of vomiting,diarrhea and other gastrointestinal symptoms.2 cases were onset of respiratory tract infection such as cough.8 cases were accompanied by fever.15 cases were accompanied by convulsions.2 cases were onset of consciousness disturbance.All 15 children underwent lumbar puncture and routine cerebrospinal fluid tests were in normal range.Electroencephalogram examination was abnormal in 13 children,showing slow activity in each lead.The cranial MRI examination of the onset of 4-6 d suggested that the lesions of the corpus callosum were characterized by high signal intensity of DWI sequence.Etiological examination of 15 children showed mycoplasma pneumoniae (MP)-IgM or-Ab positive.In 10 children,the MRI of the corpus callosum was completely restored to normal after 7-12 d.15 children were treated with anti-infection and azithromycin orally,but not with propofol or hormone.They were discharged after 4-14 days of hospitalization.All 10 children were reexamined with MRI at 7-12 days intervals.Conclusions Minor encephalitis/encephalopathy associated with reversible corpus callosum pressure in children with mycoplasma pneumoniae infection is characterized by mild encephalitis or encephalopathy.The imaging of the corpus callosum is reversible and has a good prognosis.