婴儿急性出血性白质脑炎1例并2年随访

A surviving infant with acute hemorrhagic leukoencephalitis:a two-year follow-up

目的提高儿科临床医师对急性出血性白质脑炎伴继发性癫痫的认识和诊治水平,减少儿童病死率,改善生活质量。方法 1例幸存婴儿急性出血性白质脑炎伴继发性癫痫的发病经过、临床表现、实验室检查和影像学特点、诊治经过以及24个月随访,并进行相关文献复习。结果该患儿因高热、咳嗽、抽搐给予抗感染、对症等治疗,效果差,病情进展迅速,出现意识障碍、抽搐等,在积极对症治疗基础上,加用静脉用丙种球蛋白及甲基强的松龙冲击治疗后,安全渡过危险期,症状、体征改善。急性期后口服抗癫痫药物并每日正规康复训练,现遗留有运动和语言功能障碍,但神志清晰,反应可,能独坐,吞咽等均正常。结论急性出血性白质脑炎是一种感染后中枢神经系统炎性脱髓鞘病,病情凶险,常在数天内死亡,临床表现和影像学检查帮助早期、及时、正确诊断。在积极对症、支持治疗的基础上,迅速应用免疫抑制剂是挽救生命、减少病死率的关键。

ObjectiveThe purpose of this report was to present a surviving infant case diagnosed with acute hemorrhagic leukoencephalitis (AHLE) and thus help pediatrician to facilitate rapid recognition and treatment to AHLE.Method The pathogenic course, clinical manifestation, laboratory examination, and imaging features of one surviving case infant with AHLE associated with secondary epilepsy were evaluated and followed-up for 24 months. During this process, the related literatures were reviewed.Result CT scan, serial brain MRI and CSF were performed to confirm the diagnosis of AHLE. After anti-infection and symptomatic treatment of the infant with symptoms of high fever, cough, and convulsions, the infant got worse with the occurrence of continuous convulsions and alteration of consciousness. On the basis of symptomatic treatment, high-dose intravenous immunoglobulin, methylprednisolone and other treatments were further used to the infant, and the patient recovered greatly. By taking oral antiepileptic drugs and daily regular rehabilitation training after the acute time, the patient survived though several neurological sequelae remained.ConclusionThe key to save life lies in both early diagnose and comprehensive treatment. It is difficult to avoid the sequelae of nervous system.