儿童肺炎支原体感染致缺血性脑卒中的临床特点并文献复习

Clinical characteristics of Mycoplasma pneumoniae-associated ischemic stroke in children, and a literature review

摘要:

目的：探讨肺炎支原体（MP）感染致缺血性脑卒中的临床特点，提高该病的诊疗水平。方法：回顾性分析1例MP感染致脑卒中的临床表现、实验室及影像学改变，并对相关文献进行复习。结果：该患儿以呼吸道感染起病，出现偏瘫、失语脑卒中样表现，血清（1∶320）及肺泡灌洗液MP-IgM（+），肺部影像学提示大片炎性实变、胸腔积液，头颅影像学提示以左侧为著的双侧大脑中动脉梗塞，予以阿奇霉素、激素、肝素及康复训练等综合治疗，神经系统症状、体征明显好转。结论：脑卒中是MP感染致中枢神经系统损害少见而严重的表现，头颅影像学、病原学检查有助于诊断；早期予以大环内酯类抗生素、激素、肝素治疗可改善预后。

Abstract:

OBJECTIVE: To study the clinical characteristics of Mycoplasma pneumoniae (MP)-associated ischemic stroke in children. METHODS: The case of a girl with MP-associated ischemic stroke was reported, including clinical manifestations and laboratory and imaging examinations, and related literature was reviewed. RESULTS: The girl, who was suffering from a respiratory tract infection was found to have hemiplegia and aphasia which were expressed in ischemic stroke. IgM antibody to MP in serum (1∶320) and lavage fluid was positive. Pulmonary imaging showed unilateral consolidation and pleural exudate. Cerebral neuroimaging examination showed occlusion of the bilateral middle cerebral artery, mainly on the left side. The neurological symptoms and signs were recovered after comprehensive therapy with medication (azithromycin, hormone and heparin) and rehabilitation training. CONCLUSIONS: Ischemic stroke is rare but severe manifestation of central nervous system damage in children suffering from MP infection. Cerebral imaging and etiological examinations contribute to the diagnosis. Early use of macrolide antibiotics, anticoagulant and hormone may improve the prognosis.