手足口病合并脑干脑炎的临床表现及头颅MRI特征表现

Clinical manifestations and MRI characteristics of hand, foot and mouth disease complicated with brainstem encephalitis

目的探讨手足口病合并脑干脑炎的临床表现,以及头颅MRI特征表现。方法选取2016年1月至2016年12月我院收治的重症手足口病患儿为研究对象,对56例手足口病并脑干脑炎患儿的临床表现及头颅MRI影像学资料进行分析。结果手足口病合并脑干脑炎4~7月发病率最高,发病率为82.0%;发病年龄以2岁以下为主。肠道病毒EV71阳性55例(98.2%);脑脊液异常23例(41.1%);脑电图异常50例(89.3%);血糖升高38例(67.9%);外周血中白细胞增多48例(85.7%);血清去甲肾上腺素升高56例(100.0%)。神经系统受累症状与体征:精神萎靡37例(66.1%);呕吐48例(85.7%);嗜睡17例(30.4%);惊跳51例(91.1%);肌震颤49例(87.5%);共济失调37例(66.1%);颈抵抗39例(69.6%);抽搐5例(8.9%)。56例患儿共81个病灶,包括单发31例,多发25例。其中,25例延髓、25例脑桥、20例脑干背侧及8例小脑齿状核均存在病灶。结论 EV71是手足口病合并脑干脑炎的主要病原,发病年龄以2岁以下为主。神经系统受累表现以发热、精神萎靡、呕吐、嗜睡、惊跳、肌震颤、共济失调、颈抵抗常见。脑桥和延髓是手足口病伴脑干脑炎患儿最常损害部位,损伤具有特异性。MRI表现可为手足口病伴脑干脑炎患儿的临床病情评估及治疗提供参考依据,具有临床应用价值。

Objective To investigate the clinical manifesta tions of hand,foot and mouth disease complicated with brainstem encephalitis and the cranial MRI features.Methods From January 2016 to December 2016,the children whith severe hand,foot and mouth disease admitted in our hospital were selected as the study objects.The data of clinical manifestations and cranial MRI features of 56 children with hand,foot and mouth disease complicated with brainstem encephalitis were analyzed.Results The incidence of hand,foot and mouth disease complicated with brainstem encephalitis was the highest from April to July,with the incidence rate of 82.0%,and the age of onset was mainly under 2 years old.There were EV71 positive in 55 cases(98.2%);cerebrospinal fluid abnormality in 23 cases(41.1%);EEG abnormality in 50 cases(89.3%).In affected symptoms and signs of nervous system,hyperglycemia in 38 cases(67.9%);leukopenia in peripheral blood in 48 cases(85.7%);elevated serum norepinephrine in 56 cases(100.0%).There were 37 cases of mental malaise(66.1%);48 cases of vomiting(85.7%);17 cases of drowsiness(30.4%);51 cases of convulsion(91.1%);49 cases of muscle tremor(87.5%);37 cases of ataxia(66.1%);39 cases of cervical resistance(69.6%)and 5 cases of convulsion(8.9%).A total of 81 lesions were found in 56 children,including 31 single lesions and 25 multiple lesions,including 25 cases with medulla oblongata,25 cases with pons and 20 cases with dorsal brainstem and 8 cases with cerebellar dentate nucleus.Conclusion Ev71 is the main pathogen of hand foot mouth disease combined with brainstem encephalitis,the age of onset is under 2 years old.Nervous system involvement is characterized by fever,mental depression,vomiting,lethargy,thrill,muscle tremor,ataxia and neck resistance.Pontine and medulla oblongata are the most common lesions in children with hand,foot and mouth disease with brainstem encephalitis,and the damage is specific.MRI features can provide reference for clinical evaluation and treatment of children with hand,foot and mouth disease with brainstem encephalitis,and have clinical application value.