儿童脑炎与眼底

Retinal Manifestation In Children With Encephalitis

目的研究脑炎患儿出现视网膜病变的情况，探讨眼底检查对儿童脑炎诊治的价值。方法回顾分析2000年1月至2008年6月本院儿科住院诊断脑炎或脑膜炎的患儿，对有进行眼底检查的患儿分析视网膜病变发生的情况。共65例纳入研究，男41例，女24例，年龄在3月到14岁。其中，化脓性脑炎3例，病毒性脑炎38例，结核性脑炎2例，新型隐球菌脑膜炎1例，肺炎支原体脑炎4例，局灶性脑炎5例，变态反应性脑炎5例，不明原因脑炎8例。结果所有被研究的65例患儿中，4例出现眼底出血，其中1例眼底出现Roth斑，1例出现视乳头水肿；1例结核性脑膜脑炎患儿出现继发性视神经萎缩。出现眼底出血的4例患儿中3例治疗无效死亡。5例死亡患儿中3例出现视网膜出血。结论脑炎患儿发生明显视网膜病变的几率不高，眼底出血与疾病预后存在相关性。

Objective To study the retinal manifestation in children with encephalitis,hence to evaluate the value of fundal examination for encephalitis in children. Methods All children were inpatients in the paediatric department in the second affiliated hospital of Sun Yat-sen university between January 2000 and June 2008 with a diagnosis of encephalitis or encephalomeningitis. We only analyzed the patients who had been conducted retinal examination. There were 65 patients enrolled in our study including 41 males and 24 females. Children aged between 3 months and 14 years. There were 3 cases diagnosed as purulent meningitis ,38 cases as viral encephalitis ,2 cases as tuberculous encephalitsis, 1 case as cryptococcal meningitis, 4 cases as myoplasmas pneumoniae encephalitis,5 cases as focal encephalitis and 5 cases as allergic encephalitis. Results Four of the 65 patients had retinal heamorrhages, including one case had Roth spot in retina and one case had papilledema. One child diagnosed as tuberculous encenphalitis had secondary optic atrophy. Three of the 4 cases with retinal heamorrhages died during hospitalization. Three of the 5 cases who died during hospitalization had retinal heamorrhages. Conclusion Retinopathy after encephalitis is rare, while retinal heamorrhage indicates critical condition.