神经诊断性检查在诊断儿童自身免疫性脑炎中的应用

Neurodiagnostic Studies in the Diagnosis of Autoimmune Encephalitis in Children

目的本研究收集确诊和疑诊为自身免疫性脑炎(autoimmune encephalitis,AE)的儿童患者,并进行磁共振(MRI)和脑电图(EEG)检查。回顾性的识别儿童AE患者的特异性MRI和脑电图改变,为以后快速诊断该疾病提供临床证据。方法本研究收集从2009~2013年在笔者医院就诊为自身免疫性脑炎的儿童患者。通过指南进行筛选,汇总患者相关信息,并把患者分为确诊组和疑诊组。同时收集患者头部MRI和EEG结果,观察AE患者MRI的主要病变部位和EEG的异常波形,并进行共性分析。结果本研究最终纳入18例符合纳入标准的AE患者,其中9例为确诊患者,9例为疑诊患者。18例纳入患者中有17例患者至少做过1次头部MRI。其中13例患者MRI结果有异常。笔者在9例确诊患者中发现7例患者有边缘系统的病变,且多累积双侧但不对称。5例疑诊患者具有异常的MRI显影,这些病变累积到额外的皮质(包括颞叶、顶叶和枕叶),且同样是累积双侧但不对称。18例纳入研究的患者中有16例患者进行了EEG检查。其中主要的改变有非特异性的背景波形改变,常规慢波和局灶性慢波。且在5例患者的EEG中发现了睡眠时纺锤样改变。结论本研究发现大部分AE患者都存在头部MRI和EEG异常。确诊为自身免疫性脑炎的儿童患者接受头部MRI检查后发现病变主要集中在边缘系统,且大部分患者的EEG呈现癫痫样放电,少数患者中发现EEG呈纺锤样改变。

Objective We collected children patients diagnosed as autoimmune encephalitis （AE）, and to carry out MRI and EEG. We identified specific MRI and EEG changes of patients retrospectively, and try to provide clinical evidence for the rapid diagnosis of the disease in the future. Methods This study was collected from 2009 to 2013 in our hospital patients with autoimmune encephalitis children. Through screening guidelines, aggregate patient-related information, the patients were divided into definite group and suspected diagnosis group. While collecting head MRI and EEG results in patients with AE, we observed MRI lesions and abnormal EEG waveforms of AE patients, and try to found the common places. Results The final study included 18 patients met the inclusion criteria, with 9 of definite patients, and 9 suspected patients. Among 18 enrolled patients, 17 patients were done at least once of head MRI. And the MRI results in 13 patients were abnormal. We found nine confirmed cases in 7 patients had lesions in the limbic system, and they were cumulative bilateral but asymmetric. Five suspected patients had abnormal MRI development, and these lesions accumulated to extra cortical （including temporal lobe, parietal, and occipital lobes）, and was also cumulative bilateral but asymmetric. Among 18 patients included in the study, 16 patients underwent EEG. The main changes were nonspecific background waveform changing, conventional slow wave and focal slow waves. And we found a spindle-like change in five patients. Conclusion The study found that the majority of patients with AE were present head MRI and EEG abnormalities. Diagnosed pediatric patients with autoimmune encephalitis after receiving a head MRI examination revealed lesions mainly in the limbic system, and the majority of patients presented EEG epileptiform discharges. A few patients found that EEG showed spindle-like change.