伴可逆性胼胝体压部病变轮状病毒相关性轻度脑病/脑炎临床观察

Clinical observation of rotavirus associated mild encephalopathy/encephalitis with reversible splenial lesion

目的探讨伴可逆性胼胝体压部病变轮状病毒相关性轻度脑病/脑炎(RAMERS)的临床特征。方法收集2017年12月至2018年1月江西省儿童医院神经内科收治RAMERS住院病例,回顾分析头颅MRI符合可逆性胼胝体压部病变综合征诊断标准的轮状病毒肠炎相关性脑病患儿临床及脑电图特征,采用SPSS19.0软件进行数据分析。结果14例RAMERS入组病例,男9例,女5例,年龄(27.00±6.45)个月,所有病例至少抽搐1次,均表现为全面强直-阵挛性发作,57.14%(8/14例)发作为丛簇性(≥2次/d),抽搐发生在胃肠症状出现后(3.14±1.29)d;64.29%(9/14例)有病理性发热(≥38℃);71.43%(10/14例)脑电图表现为非特异性广泛性慢波背景活动,21.43%(3/14例)正常,7.14%(1/14例)慢波背景活动合并额、中央区偶见低幅尖波,均在2周后复查恢复正常;9例进行脑脊液检查常规、生化正常,脑脊液病原学检测阴性。12例头颅MRI为胼胝体压部孤立性病变,2例合并对称性白质病变。结论RAMERS是可逆性胼胝体压部病变综合征一种特殊类型,多见于婴幼儿,以胃肠炎和良性惊厥为特征性,且一半以上表现为频发抽搐(≥2次/d),脑电图以非特异性慢波背景活动多见,预后良好,头颅MRI复查无需作为常规的推荐,以免过度医疗。

Objective To explore the clinical characteristics of rotavirus associated mild encephalopathy/encephalitis with reversible splenial lesion(RAMERS). Methods RAMERS cases were collected from December 2017 to January 2018 at the Department of Neurology, Jiangxi Children′s Hospital.The clinical and electroencephalogram characteristics of 14 patients with RAMERS were retrospectively investigated.Data was analyzed by using SPSS 19.0 software. Results Fourteen cases of RAMERS were tested, 9 males, and 5 females, with the average age of (27.00±6.45) months, and all cases suffered from the generalized tonic-clonic seizures, 57.14%(8/14 cases) had cluster seizure (at lest 2 times/day), convulsions occurred(3.14±1.29) days after gastroenteritis, and 64.29%(9/14 cases) had pathologic fever (38 ℃ or higher). The background of electroencephalogram(EEG) was characterized by nonspecific rhythmic slow waves in 10 cases(71.43%, 10/14 cases), normal in 3 cases (21.43%, 3/14 cases), and interictal EEG performed in 1 case(7.14%, 1/14 cases) which was characterized by focal discharges of spikes in the forehead, central, and all of the EEG manifestations go back to normal after 2 weeks.Twelve patients′ brain MRI showed solitary splenium of corpus callosum lesion, and two showed splenium of corpus callosum and bilateral symmetry white matter lesion. Conclusions RAMERS is a special type of reversible splenial lesion syndrome, which occurs predominantly in infants and young children.It is characterized by gastroenteritis, benign infantile convulsion, cluster seizure and nonspecific rhythmic slow waves in the background of EEG.Prognosis is usually excellent.Head MRI reexamination is not recommended as a routine procedure to avoid overtreatment.