肺炎支原体肺炎合并脑梗死三例分析

Mycoplasma pneumonia associated with cerebral infarction in 3 children

目的分析探讨儿童肺炎支原体肺炎合并脑梗死的病例特点和诊断方法。方法总结3例肺炎支原体肺炎合并脑梗死患儿的临床表现、影像学改变，并复习相关文献。结果3例患儿均为学龄或学龄前期儿童，以呼吸道感染起病，出现急性偏瘫，伴或不伴抽搐发作。血清肺炎支原体抗体IgM测定阳性。肺部影像学提示大片炎性实变，有合并肺不张或胸腔积液，头颅影像学提示大脑中动脉栓塞及相应供血区脑梗死。予阿奇霉素抗感染治疗及抗凝、溶栓等对症治疗，神经系统症状、体征有不同程度好转。结论根据3例患儿呼吸道症状及肺部影像学改变，肺炎支原体肺炎诊断成立，同时神经系统症状体征及头颅影像学改变，诊断合并脑梗死。

Objective To study the clinical features and diagnostic methods of mycoplasma pneumonia complicated with cerebral infarction. Method Data of 3 children with mycoplasma pneumonia who developed cerebral infarction, including clinical manifestations and imaging were collected, analyzed and the literature was reviewed. Result All the cases were pre-school or school-aged children, who developed the respiratory infection initially, the neurological symptoms were acute hemiparesis, with or without convulsion. The lgM antibody to Mycoplasrna paeumoniae （Mp） was positive. Pulmonary imaging showed unilateral consolidation with atelectasis and pleural exudate. Neuroimaging showed occlusion of middle cerebral artery and infarction of its territory. After giving azithromycin, anti-coagulative and thrombolytic treatments, the neurological deficits recovered to some extent. Conclusion Mycoplasma pneumonia were diagnosed based on respiratory symptoms and pulmonary imaging, the accompanied cerebral infarction was confirmed by neurological and neuroimaging findings.