急性脑部炎症合并视觉障碍患儿22例临床特征及预后

Clinical characteristics and prognosis of twenty-two children diagnosed with acute encephalitis with visual impairment.

目的分析急性脑部炎症合并视觉障碍患儿临床特征及预后。方法对2003年1月至2014年6月中国医科大学附属盛京医院小儿神经内科22例临床诊断为急性脑部炎症合并视觉障碍患儿的临床症状、实验室检查、视觉诱发电位、神经影像学特点等临床资料进行回顾性分析。结果发病〈1周就诊入院的10例、1～2周8例、〉2～4周2例、〉4周2例。以视觉障碍首发就诊的7例。确诊为病毒性脑炎合并视神经炎9例,病毒性脑炎合并视神经乳头炎1例,病毒性脑炎及化脓性脑膜炎合并视觉障碍性质待定各1例,播散性脑脊髓炎合并视神经炎的2例,脑干脑炎合并暴露性眼炎的1例,病毒性脑炎合并右眼晶体点状混浊、双眼视网膜发育不良的1例,视神经脊髓炎1例,病毒性脑炎合并皮质盲1例,播散性脑脊髓炎合并视乳头炎、疑似小柳原田综合征1例,多发性硬化症可能性大3例。全部患儿均进行了视觉诱发电位检查,其中视觉传导通路异常18例。10例行眼底照相,结果异常7例。均行头磁共振（MR）平扫检查,结果异常10例,其中6例脑内病变范围广泛。18例行丙种球蛋白联合激素冲击治疗,其中出院时14例视觉障碍症状好转。出院后随访6个月至8年,20例预后较好、2例预后较差。结论急性脑部炎症合并视觉障碍病因多样,除考虑常见病,如视神经炎、视神经乳头炎、视神经脊髓炎、脑血管病外,还应考虑到少见疾病,如皮质盲、小柳原田综合征等。早期行视觉诱发电位、眼底照相检查对于疾病诊断与鉴别有意义,积极治疗对改善预后有重要作用。

ObjectiveTo analyze the clinical characteristics and prognosis of acute encephalitis with visual impairment in children.MethodsThe clinical features,including clinical manifestations,laboratory tests,Flash visualevoked potential and cranial MRI,in 22 patients diagnosed with acute encephalitis with visual impairment in childrenwere retrospectively analyzed.Results The disease course was less than one week in 10 cases. The disease course ofeight cases was between one week and two weeks;two cases were between two weeks and four weeks;two cases wereover four weeks. Seven cases had visual impairment as the first symptom. One case was with the diagnosis of viral encephalitis with cortical blindness. Nine cases were with the diagnosis of viral encephalitis with optic neuritis. One case waswith the diagnosis of encephalitis with neuropapillitis. One case was with the diagnosis of disseminated encephalomyelitis with optic neuritis. Two cases were with the diagnosis of disseminated encephalomyelitis with optic neuritis. One casewas with the diagnosis of brainstem encephalitis with exposure keratitis. One case was with the diagnosis of encephalitiswith lens opacity and retinal dysplasia. One case was with the diagnosis of ophthalmoneuromyelitis. One case was likelywith the diagnosis of Vogt-Koyanagi-Harada syndrome. In all the cases of Flash visual evoked potential,eighteen wereabnormal. In the ten cases of fundus photography,seven were abnormal. In all the cases of cranial MRI,ten were abnormal and six suffered from extensive pathological changesin the brain. In the eighteen cases of hormone therapy,fourteen had good effects. The time of post hospitalizationfollow-up ranged from 6 months to 8 years. The prognosis of 20 patients was good. Two patients＇ prognosis was bad.ConclusionsThere are different kinds of etiology and diseases in children who are diagnosed with acute encephalitis with visual impairment. Flash visual evoked potential and fundus photography are of important significance in the early stages. High doses of IVIG corticosteroids and hyperbaric oxy-gen therapy play a key role in improving the prognosis of disease.