儿童伴胼胝体压部可逆性病变的轻度脑炎／脑病25例临床分析

Clinical analysis of 25 children with mild encephalitis/encephalopathy with a reversible splenial lesion

目的探讨儿童伴胼胝体压部可逆性病变的轻度脑炎／脑病（MERS）的临床表现、影像学特征及预后。方法对2013年11月至2016年3月首都医科大学附属北京儿童医院收治的25例MERS患儿的临床及影像学资料进行回顾性分析。25例患儿起病年龄6个月-13岁，因发病年龄及不同年龄的临床表现具有特征性，将其分为2组：≤6岁组20例，起病年龄为6个月～3岁9个月（平均2岁2个月）；〉6岁组5例，起病年龄为9岁3个月～13岁（平均10岁10个月）。结果25例患儿中19例有前驱感染史，其中消化道感染10例，均为≤6岁组患儿；呼吸道感染9例，6例为≤6岁组患儿，3例为〉6岁组患儿。主要临床表现为抽搐（18／25例，72．0％），发热（17／25例，68．O％），呕吐（11／25例，44．0％），意识障碍（11／25例，44．0％）。≤6岁组主要表现为抽搐（18／20例，90．0％）。〉6岁组主要表现为发热（3／5例，60．0％），头痛、头晕（2／5例，40．O％），均无抽搐发作。25例中肝损伤8例，心肌酶升高10例，血钠降低9例。头颅磁共振成像（MRI）检查示21例为I型MERS，仅累及胼胝体压部；4例为Ⅱ型MERS，除胼胝体压部外，还累及大脑深部白质、皮质下白质（半卵圆中心）。经抗感染、降颅压等治疗8～56d（平均16．5d），复查头颅MRI消失。结论MERS儿童发病以≤6岁儿童多见，≤6岁患儿前驱感染以消化道感染常见，〉6岁组以呼吸道感染常见。儿童患者主要表现为发热、抽搐、呕吐、意识障碍等。感染和低钠血症是儿童MERS的主要病因，头颅MRI检查是首选的影像学检查方法。

Objective To discuss the clinical manifestations, imaging features and prognosis of children with mild encephalitis/encephalopathy with a reversible splenial lesion （MERS）. Methods Twenty - five patients with MERS admitted to Beijing Children＇s Hospital, Capital Medical University, between November 2013 and March 2016 were enrolled and their clinical and imaging data were retrospectively analyzed. Ages of onset of these 25 cases were from 6 months to 13 years old. Because of different clinical manifestations in different onset ages, these 25 cases were divided into 2 groups： ≤ 6 years old group （20 cases）, with the onset age of 6 months to 3 years and 9 months old （average 2 years and 2 months） ; 〉 6 years old group（5 cases）, with the onset age of 9 years 3 months to 13 years old （average 10 years and 10 months）. Results Nineteen cases among the 25 patients had infection histmy before onset, including 10 cases of digestive tract infection（ all were ≤6 years old children ）,9 cases of respiratory tract infection （6 children ≤6 years old and 3 children 〉 6 years old）. The main clinical manifestations included convulsion （18/25 cases,72.0% ）, fever （ 17/25 cases, 68.0% ） , vomiting （ 11/25 cases, 44.0% ） , and disturbance of consciousness （11/25 cases,44.0% ）. The main clinical manifestation of ≤6 years old group was convulsion （18/20 cases, 90.0% ） ,while the main clinical manifestations of the 〉 6 years old group were fever（ 3/5 cases, 60.0% ）, headache and dizziness（2/5 cases,40.0% ） , and none of the patients in 〉 6 years old group had convulsion. Eight cases had liver function injury, myocardial enzymes increased in 10 cases, and hyponatremia occurred in 9 cases. Magnetic reso- nance imaging （MR1） showed 21 cases were type I MERS（only involving corpus callosum） ,and 4 cases of type lI MERS which involved corpus callosum as well as deep brain white matter, subcortical white matter （centrum semiovale）. MRI lesions disappeared after 8 -56 days （average 16.5 days） of anti - infection and reducing intracranial pressure treatment. Conclusion MERS is more common in≤6 years old children, and digestive tract infection is com- mon in ≤6 years old children,while respiratory tract infection is common in 〉 6 years old children. The symptoms in children are mainly manifested as fever, convulsion, vomiting, conscious disturbance, and so on. Infection and hyponatremia are the main causes of MERS in children. MRI is the first choice of imaging examination methods.