肠道病毒71型感染手足口病合并急性弛缓性麻痹的临床和影像学特征

Clinical and Neuroimaging Features of Enterovirus Type 71 Infected Hand-Foot-Mouth Disease Combined Acute Flaccid Paralysis

目的:通过病例观察和文献复习探讨肠道病毒71型(EV71)感染合并急性弛缓性麻痹(AFP)的临床、影像学表现及特征。方法:报告2008-2010年中国海南EV71感染流行期间9例伴有AFP的EV71型感染手足口病患儿临床、MRI表现,并做文献复习,分析其可能机制。结果:9例患儿中,单侧肢体无力4例(其中单下肢3例,单上肢1例),双侧肢体无力3例(双下肢2例,双上肢1例),四肢无力2例,合并脑干脑炎3例。脊髓MRI示颈到圆锥髓内不同范围条形长T1长T2信号,病变集中于脊髓颈段及胸9-圆锥水平,横轴位显示脊髓双侧或单侧前角长T1长T2信号。3例合并脑干脑炎患者颅脑MRI示桥脑、延髓、中脑后部点状或模糊片状长T1、长T2信号,脊髓MRI增强扫描表现为受累脊髓前角轻度强化,同侧前根明显强化。结论:EV71型感染手足口病合并AFP损害部位常位于颈段及胸9-圆锥水平脊髓前角及前根。MRI是评价手足口病神经系统损害的有效方法,影像学表现具有相对特异性,对评估病情和判断预后有重要价值。

Objective：To observe the clinical and neuroimaging features of enterovirus 71（EV71） infected hand-foot-mouth disease（HFMD） combined with acute flaccid paralysis（AFP）.Methods：Nine cases of HFMD with acute flaccid paralysis during the recent EV71 outbreaks in Hainan Province,China from May 2008 to September 2010 were retrospectively studied,and the related literatures were reviewed.Results：Of the nine cases,three had monoplegia of lower limbs,one had monoplegia of upper limb,two had paraplegia,one had plegia of both upper limbs and two had quadriplegia.Spinal MRI examination in all the cases showed hyper-intense lesions on T2-weighted images,predominantly in the impaired anterior horn regions of the spinal cord,and displayed long T1 signals and long T2 signals.Lesions of spinal cord chiefly occurred in cervical and T9 spinal cord to conus medullaris.In addition,the pons,medulla,or midbrain was also involved in three cases.Mild enhancement of anterior horn and strong enhancement of the bilateral ventral root were seen in the contrast-enhanced axial T1-weighted image.Conclusion：In HFMD combined with AFP cases,MRI of spinal cord shows unilateral or bilateral lesions in the anterior horn regions of the spinal cord（cervical spinal cord or T9 to Conus medullaris） on Tl/T2-weighted images.MRI is an effective method to investigate AFP combined with the enterovirus 71 epidemic.MRI examination is particularly valuable for the diagnosis and prognosis of AFP because of its high sensitivity and accuracy.