肠道病毒71型引起急性弛缓性瘫痪:二例报告并文献复习

Enterovirus 71-induced acute flaccid paralysis:two case reports with review of literatures

目的探讨2例手足口病并发急性弛缓性瘫痪患儿的临床特征及预后。方法对2例手足口病并发急性弛缓性瘫痪患儿的临床表现,以及MRI、脑电图、神经电生理学检查结果及预后进行回顾分析,并对其瘫痪肢体的功能恢复情况进行随访。结果 2例患儿均为婴儿,于病程第7天出现急性弛缓性瘫痪,发病1～2d即进展至危重程度。临床表现为单侧肢体瘫痪及三肢瘫痪,肌力0～3级。MRI呈现脑外间隙增宽,相应颈段脊髓呈长T_2信号;脑电图提示背景慢波,左右对称;神经电生理学检查相应患肢呈小至中量自发电位;运动单位电位时限增宽,振幅下降,大力收缩时募集差;神经电图提示运动神经传导速度正常,末端潜伏期正常;肌肉动作电位波幅不同程度下降,感觉神经传导速度正常,F波消失。肢体瘫痪于病程第2～3周开始恢复。结论手足口病并发急性弛缓性瘫痪以婴儿期好发,肢体瘫痪发生于病程1周左右,发病后1～2d瘫痪即达严重程度。临床表现为单侧肢体或多肢瘫痪,病情恢复迅速。MRI、脑电图、神经电生理学检查对明确诊断和判断预后具有重要价值。

Objective To investigate the clinical characteristics and prognosis of hand-foot-andmouth disease （HFMD） complicated with acute flaccid paralysis （AFP）. Methods The clinical features, MRI, electroencephalogram （EEG）, neurophysiologieal examination and prognosis of 2 cases of HFMD complicated with AFP were analyzed retrospectively. Functional recovery was followed up for 9 weeks. Related literatures were reviewed. Results Both of the two cases are infants. AFP occurred at the 7 th day, and advanced to severe degree at 1-2 d after onset. Paralysis affected one limb in one case and 3 limbs in another case. Muscle strength ranged from 0 to 3 degree. Cranial MRI indicated broadened extraeerebral lacuna. Cervical MRI presented long T2 lesion in the spinal cord. EEG recorded symmetrical slow background waves. Neurophysiologieal examination showed minor or moderate spontaneous potential at the paralytic limb. The duration of motor unit potential was prolonged, but the amplitude declined. Motor nerve conduction velocity was normal. Terminal latent period was intact. The amplitude of muscle motor potential declined. Sensory nerve conduction velocity was normal. F wave disappeared. Both of the 2 patients began to recover 2-3 weeks later. Conclusion HFMD complicated with AFP usually affects infant. Paralysis usually occurs around I week during the course of HFMD and progresses rapidly to peak 1-2 days after onset. Unique or multi limbs can be affected and the paralysis can recover rapidly. MRI, EEG, and neurophysiological examination are valuable for diagnosis and predicting prognosis.