儿童肺炎支原体感染相关性脑梗死

Cerebral Infarction Associated with Mycoplasma Pneumoniae Infection in Children

目的探讨儿童肺炎支原体(MP)感染相关性脑梗死的发病机制、临床表现、影像学特点及预后。方法回顾性总结分析2008年6月-2011年12月本院收治的22例MP感染并脑梗死患儿的临床表现、影像学改变、实验室检查结果、治疗及预后,复习相关文献,并进行比较。结果患儿中女童(15例)多于男童(7例),平均发病年龄为6.82岁(13个月～13岁),68.2%(15/22例)的患儿存在呼吸道感染表现。血清MP抗体阳性检出率为100%,而脑脊液阳性率相当低(1/22例)。肺部影像学提示肺炎改变7例(32%)。头部影像学以缺血性梗死为主(20/22例),出血性梗死少见(3/22例)。病灶主要位于基底核,占63.6%(14/22例)。头颅磁共振脑血管成像(MRA)大多(11/18例)异常,以大脑前循环动脉异常为主,其中大脑中动脉占54.5%。经内科保守治疗,患儿临床症状、体征均明显改善。结论儿童MP感染可并脑梗死,呼吸道感染表现可有可无,临床主要表现为病变对侧肢体活动障碍及中枢性面瘫,头颅MRA多表现为大脑前循环异常,基底核、颞叶、丘脑为常见梗死区,经内科保守治疗预后良好。

Objective To investigate the mechanism, clinical manifestations, neuroimaging characteristics and prognosis of cerebral in- farction associated with mycoplasma pneumoniae （MP） infection in children. Methods Data of 22 cases suffering from cerebral infarction as- sociated with MP infection from Jun. 2008 to Dec. 2011 ,including clinical manifestations, imaging and laboratory examinations, were collected and analyzed. Literature were reviewed and compared with the present study. Results There were more girls （ 15 cases） than boys （7 cases） in this study. The mean age was 6.82 years （ 13 months to 13 years old）. About 68.2% （ 15/22 cases） of the patients had preceding symp- toms of respiratory tract infection. The serum MP antibody was positive in all patients. However,there was only 1 case whose MP antibody was positive in cerehrospinal fluid. Chest X - ray showed pneumonia in 7 cases （32%）. Brain images showed ischemic infarction in most cases （ 19/22 cases） rather than hemorrhage infarction. Basal ganglia was most commonly affected （ 14/22 eases,63.6% ）. Eleven out of 18 cases showed abnormal magnetic resonance angiography,and the anterior cerebral circulation was mostly affected,among which, 54.5% located in the middle cerebral artery. After conservative therapy, the neurological deficits recovered to some extent. Conclusions Cerebral infarction is a rare neurological complication of MP infection. The onset of MP respiratory tract infection may or not appear. The major clinical manifestations are hemiparesis and facial paresis eontralateral to the lesion. Because of abnormality of anterior cerebral circulation in brain magnetic reso- nance angiography, basal ganglia, temporal and thalamic region are the common lesions. Generally speaking, the prognosis is good after conser- vative therapy.