儿童抗N-甲基-D-天冬氨酸受体脑炎的影像表现与临床特征

Imaging and clinical features of anti-N-methyl-D-aspartate receptor encephalitis in children

目的:分析儿童抗N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体脑炎头颅MRI表现与临床特征。方法:对34例抗NMDA受体脑炎患儿进行影像资料与临床资料综合分析,并在入院时、入院治疗6月后全部进行改良的疾病严重程度评分(mRS)。结果:34例患儿中17例MRI表现异常,MRI表现异常者T2WI、FLAIR序列呈高信号。异常信号灶多分布于颞叶、岛叶、额顶枕叶,部分病灶亦可见于基底节、丘脑、胼胝体及脑干、小脑,其中6例伴有脑膜和/或脑实质病灶明显强化。首发症状癫痫位于第一位(74%),其次精神行为异常(35%)、发热(32%)、运动障碍(17.6%)、意识障碍(17.6%)。癫痫发作、精神行为异常、发热、运动障碍、意识障碍、单纯疱疹病毒感染患儿MRI表现正常者与MRI表现异常者差异无统计学意义(P>0.05),34例患儿中MRI表现正常与MRI表现异常的年龄分布差异无统计学意义(P>0.05)。入院mRS评分,MRI表现正常者与MRI表现异常者差异无统计学意义(P>0.05),治疗6月后mRS评分,MRI表现正常者平均评分低于MRI表现异常者,差异有统计学意义(P<0.05)。结论:儿童抗NMDA抗体受体脑炎MRI表现正常者预后较好、治愈率高,MRI异常者常提示预后较差。

Objective:To discuss the imaging and clinical features of anti-N-methyl-D-aspartate(NMDA)receptor encephalitis patients in children.Methods:Thirty-four anti-NMDA receptor encephalitis patients in children were included.We analyzed the brain MRI findings and the clinical characteristics.The modified Rankin scale(mRS)was applied on admission and after 6 months for each patient.Result:The brain MRI was abnormal in 17/34 patients.The initial MRI was abnormal on T2 or fluid-attenuated inversion recovery(FLAIR)as hyper-intensity signals.They were seen in the temporal lobe,insular lobe,frontal and parietal and occipital lobe.Some of them were also found in basal ganglia,thalamus,corpus callosum,brain-stemand cerebellum.Six has leptomeningeal enhancement and/or abnormal enhancement of parenchyma.The first symptom is seizure,followed by mental and behavioral disorders(35%),fever(32%),motor disorders(17.6%)and loss of consciousness(17.6%).There were no statistically significant differences between the MRI findings and clinical presentations(seizure,mental and behavioral disorders,fever,motor disorders,oss of consciousness,erpes simplex virus infection)(P>0.05).There was no statistically significant difference in MRI findings(normal or abnormal)between 34 patients with different age(P>0.05).There was no statistically significant difference in MRI findings(normal or abnormal)between the mean mRS score at 0-month follow-up(P>0.05).The mean mRS score at the 6-month follow-up was significantly lower in patients with normal MRI than in patients with abnormal MRI(P<0.05).Conclusion:The patients with normal MRI had improved outcomes,and the patients with abnormal MRI had poor outcoms.