小儿感染后急性小脑共济失调临床影像特点及其相关分析

Correlative study of clinical-imageological in infantile acute cerebellar ataxia after infection

目的初步探讨小儿感染后急性小脑共济失调的磁共振成像（magnetic resonance imaging,MRI）特征及其与临床症状之间的相关性。材料与方法结合文献回顾性分析30例小儿感染后急性小脑共济失调的临床及影像资料。结果30例患儿均表现为小脑齿状核对称性长T2信号,18例为单纯小脑齿状核病变,其余12例合并桥脑背侧-小脑上脚-上髓帆、大脑脚、延髓、颈髓及基底节长T2信号。其中以小脑齿状病变发生率最高、最具有特征性,与其他部位比较,差异有统计学意义（P〈0.05）;小脑症状出现至初查/复查MRI的时间〈3d者,患儿临床症状重,颅内病灶范围广,多部位累及;3~5 d者,症状好转,齿状核病灶范围缩小;6~9 d者,患儿临床症状明显好转,齿状核病灶消失或回缩至第四脑室旁;〉9d者,患儿临床症状痊愈或明显好转,颅内病灶消失。总体呈正向相关,且病灶的消失早于临床症状、体征。结论小儿感染后急性小脑共济失调具有特征性的影像表现,密切结合临床,能够为疾病诊断及预后提供有价值的信息。

Objective： To investigate the magnetic resonance imaging（MRI） manifestation of infantile acute cerebellar ataxia after infection, and study the correlation of clinic-imageologic. Materials and Methods： The clinical data and imaging manifestation of 30 infant with acute cerebellar ataxia after infection were analyzed retrospectively. Results： The lesion shows hyperintensity signal on T2 WI in cerebellar dentate nucleus in all patients. Eighteen cases were cerebellar dentate nucleus lesions, and the long T2 signal was showed in the bridge on the back and sides of the brain-the cerebellum on foot-pulp sail, cerebral peduncle, medulla oblongata, cervical spinaland basal ganglia. Among them, the lesion on the cerebellar dentate nuclei is characteristic, comparing with other parts of the incidence, the difference between groups was significant（P〈0.05）. If the time span from showing cerebellar symptoms to the preliminary MRI investigation less than 3 days, children had severe clinical symptoms and the lesions wide-ranging, other sites were also involved; The symptoms were improved and the lesions of dentate nucleus range narrow between 3 and 5 days; The children＇s clinical symptoms improved signifi cantly and the lesions of dentate nucleus disappeared or retracted to the side of the fourth ventricle between 6 and 9 days; The lesions wae disappeared when the time span was more than 9 days, the clinical symptoms of the children were cured or improved signifi cantly. In general, it is positive correlation of clinical-imageological, compared with clinical symptoms, the lesions disappeared faster. Conclusion： There are characteristic imaging manifestations in infantile acute cerebellar ataxia after infection. MRI has an advantage of detecting lesions, also can provide useful information for clinical diagnosis and prognosis.