儿童早期复发型视神经脊髓炎的成功治疗1例(英文)

Successful treatment of an early recurrence of neuromyelitis optica in a child

目的:报告罕见的儿童早期复发型视神经脊髓炎的成功治疗1例。方法:病例报告。结果:患者,女,8岁,卡达山族,突发性双眼视力下降5d后,出现左下肢肌力减弱症状。发病时,患者双眼视力为光感,伴双眼视盘充血水肿。脑部与脊髓MRI显示:右额叶及颈5水平脊髓后部有白色增强信号的病变,诊断为视神经脊髓炎,给予静脉注射甲基强的松龙冲击治疗,随后转为口服泼尼松龙维持治疗。1mo后症状逐渐缓解。然而,停止口服泼尼松龙1wk后症状复发。复查脑脊髓MRI显示:在脑部的同样区域以及脊髓颈3到颈5段仍有持续的炎症存在,遂立即给予甲基强的松龙冲击治疗,并口服激素延缓减量。2mo后,患者已经可以行走并参与学校活动,此时双眼的视力提高到0.6,但还残留少量的色觉损害,下肢神经检查也正常。口服递减药量的泼尼松龙维持治疗持续4mo,随访1a没有复发。最终,患者视力恢复到右眼0.8,左眼0.6。结论:对于突发性双眼视力下降伴随肢体肌力减弱的儿童患者,必须对视神经脊髓炎有所警惕。早期诊断及治疗有利于患者的康复。

·AIM：To report unusual presentation and good outcome of neuromyelitis optica（NMO）in a child.·METHODS：Case Report.·RESULTS：An 8-year-old girl presented with 5-day history of sudden bilateral visual deterioration followed by left lower limb weakness.Visual acuity was perception to light in both eyes.Funduscopy revealed bilateral hyperaemic swollen optic discs.MRI of brain and spine revealed enhancing white matter lesions in the right frontal lobe and spinal cord at C5 level.She was diagnosed NMO and treated with intravenous methylprednisolone and tapering doses of oral prednisolone as maintenance therapy.Symptoms gradually improved 1 month after treatment.However,she presented with similar presentation 1 week after stopping oral prednisolone.MRI of brain and spine were reviewed and showed enhancing lesion in the right frontal lobe and longitudinal segment of spinal cord from C3 to C5 level.She was promptly given intravenous methylprednisolone for 5 days followed by prolonged tapering of oral prednisolone over 6 months period.After 2 months,she was able to walk and attend activities of school.Visual acuity was improved to 6/10 in both eyes and neurological examination was normal.There was no recurrence during the next year.Final visual acuity was 6/7.5 in the the right eye and 6/10 in the left eye.·CONCLUSION：The diagnosis of NMO should be kept in mind although it is unusual presentation in child presented with bilateral visual loss and unilateral lower limb weakness.Early diagnosis and treatments would yield good outcome to the patient.·