儿童伴可逆性孤立胼胝体压部病变的轻度脑炎/脑病临床及影像学特点

目的:分析儿童伴可逆性孤立胼胝体压部病变的轻度脑炎/脑病(MERS)的临床特征及影像学特点。方法:选取2011年8月至2015年8月就诊于内蒙古医科大学附属医院儿科的15例临床诊断为MERS的患儿,进行头颅MRI、腰椎穿刺、长程EEG、血生化及病原体等检查,并对其临床特征进行分析。结果:15例患儿均有发热、咳嗽或腹泻等前驱感染症状,之后出现一过性轻度嗜睡,伴有下列症状之一:惊厥、头痛伴呕吐、共济失调。查体多数无神经系统阳性体征。其中2例血检支原体鄄IgM(+),3例大便检测出轮状病毒鄄IgM。血生化大多显示低钠血症。所有患儿头颅MRI均出现胼胝体压部孤立性、边界清楚的圆形或椭圆形病灶。经常规抗感染治疗后,1~2周内复查头颅MRI上述病灶完全恢复正常。结论:儿童MERS是一种急性胼胝体压部可逆性病变的轻微脑病,可能与感染相关,经抗感染治疗,1~2 周内可完全恢复。

The Clinical and Imaging Characteristics of Mild Encephalitis/Encephalopathy with Reversible Splenial Lesion of Corpus Callosum in Children

Objective: To analysis the clinical features and imaging characteristics of mild encephalitis/ encephalopathy (MERS) with reversible splenial lesion of corpus callosum in children. Methods: From August 2011 to August 2015, fifteen children were diagnosed with MERS and treatment in the Affiliated Hospital of Inner Mongolia Medical University. All children underwent following examinations, including cranial magnetic resonance imaging (MRI), lumbar puncture, long-range EEG, blood biochemical and pathogens inspection. The clinical and imaging characteristics of all MERS cases were analyzed. Results: All 15 children had symptoms of fever, cough or diarrhea, followed by a transient mild lethargy, in addition, accompanied by one of the following symptoms: convulsions, headache and vomiting, ataxia. No positive signs were found during central nervous system examination in most of cases. Mycoplasma-IgM had been detected in 2 children''s blood, while rotavirus-IgM also had been detected in 3 children''s feces. The results of blood biochemical examination showed hyponatremia were common. The MRI scans showed reversible splenial lesion of corpus callosum, round or oval focus with clear border in all children. Conclusion: MERS in children is an acute mild encephalitis/encephalopathy with reversibility splenial lesion of corpus callosum, may be related to infection, and anti-infective treatment is an effective treatment method so that MERS children can recover completely after 1 to 2 weeks.