儿童轻微脑炎/脑病伴可逆性胼胝体压部病变综合征的临床特点

Clinical features of mild encephalitis/encephalopathy with a reversible splenial lesion in children

摘要:

目的 探讨儿童轻微脑炎/脑病伴可逆性胼胝体压部病变综合征（MERS）的临床特点。方法 对8例MERS患儿的临床资料进行回顾性分析。结果 患儿发病年龄10个月至12岁，平均5岁2个月。主要临床特点为：有前驱感染史，其中包括发热5例，呕吐4例。临床表现为惊厥6例，意识障碍、阵发性视觉异常各3例。颅脑MRI弥散加权成像表现为胼胝体压部高信号，其中1例同时伴有双侧半卵圆中心、部分颞叶白质对称多发长T1、长T2信号。全部病例5~30 d后复查MRI，异常信号消失。随访3个月至2年，8例患儿神经发育均无异常。结论 儿童MERS发病多与感染有关；颅脑MRI 弥散加权成像示胼胝体压部高信号为其特征；多数患儿预后良好。

Abstract:

Objective To investigate the clinical features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children. Methods The clinical data of 8 children with MERS were retrospectively analyzed. Results The mean age of onset was 5 years and 2 months (range 10 months to 12 years). The major clinical features included a history of prodromal infection, and among these children, 5 had pyrexia and 4 had vomiting. Of all the children, 6 were manifested as convulsion and 3 each were manifested as disturbance of consciousness and paroxysmal paropsia. Cranial diffusion-weighted magnetic resonance imaging (MRI) showed high signals in the splenium of the corpus callosum. Among these children, one child had symmetric and multiple long T1 and long T2 signals in the bilateral centrum semiovale and part of the temporal white matter. MRI reexamination performed after 5-30 days showed the disappearance of abnormal signals in all the children. The children were followed up for 3 months to 2 years, and no child experienced abnormal neurodevelopment. Conclusions The development of MERS in children is closely associated with infection. MERS is characterized by high signals in the splenium of the corpus callosum on cranial diffusion-weighted MRI. Most children have good prognosis.