甲型流感病毒感染合并急性偏瘫1例

Influenza A virus infection combined with acute hemiplegia:A case report and literature review

目的总结1例甲型流感病毒感染合并急性偏瘫的临床特征及诊治要点,并进行文献复习,提高对该类疾病的认识。方法总结我科收治的1例甲型流感合并急性偏瘫患儿临床特征及诊治经过,并检索文献,对检索到的10例甲型流感并急性偏瘫或脑梗死病例及本文收治的1例进行分析。结果国内外共报道11例甲型流感并急性偏瘫或脑梗死病例,7例儿童,4例成人。其中国内4例儿童,3例为病毒性脑炎、1例为甲型流感触发的烟雾病患儿右额叶及半卵圆中心梗死;苏丹1例50岁女性为甲型流感病毒感染引起的右侧大脑中动脉供血区及小脑梗死;澳大利亚1例3岁女童为急性坏死性脑病;韩国1例32岁女性为甲型流感的罕见并发症——静脉梗死;日本4例,1例73岁男性为甲型流感病毒感染并发腔隙性梗死,1例2岁男童为偏侧惊厥-偏瘫-癫痫综合征,1例41岁女性为甲型流感触发的伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病患者多发性边缘区梗死,1例2岁女童为甲型流感病毒感染相关的色素失禁证患儿迟发性脑动脉病。结论甲型流感病毒感染并急性偏瘫病因复杂,流感相关性脑病/脑炎、脑血管病等均需考虑,及时完善影像学乃至基因等相关检查,可能有助于准确诊断,有效干预。甲型流感病毒感染可能触发常染色体显性遗传性脑动脉、烟雾病患者的脑梗死,以及色素失禁证患儿的迟发性脑出血,其机制可能是在原有血管病变的基础上,引发了细胞因子风暴,导致组织低灌注、动脉狭窄、闭塞或出血等,有待于进一步的研究阐明。

Objective To summarize the clinical characteristics and key points of diagnosis and treatment of a case of influenza A virus(IAV)infection combined with acute hemiplegia,and to enhance the understanding of this disease through literature review.Methods The clinical manifestations,diagnosis and treatment of a case of IAV infection combined with acute hemiplegia in our department were summarized,and the relevant literature was searched.Ten previously reported cases of IAV infection combined with acute hemiplegia or cerebral infarction and 1 case in this paper were analyzed.Results A total of 11 cases of IAV infection combined with acute hemiplegia or cerebral infarction were reported,including 7 children and 4 adults.Among them,there were 4 pediatric cases in China,3 cases of viral encephalitis and 1 pediatric case of right frontal lobe and hemioval central infarction triggered by IAV infection combined with moyamoya disease.A 50-year-old female in Sudan had a right middle cerebral artery territory and cerebellum infarction caused by IAV infection.A 3-year-old girl in Australia had acute necrotizing encephalopathy.A 32-year-old female in Korea had venous infarction,which was an uncommon complication of IAV infection.There were 4 cases in Japan,including a 73-year-old male with IAV infection complicated with lacunar infarction,a 2-year-old boy with hemiconvulsion-hemiplegia-epilepsy syndrome,a 41-year-old female with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL),who had multiple border-zone infarcts triggered by IAV infection,and a 2-year-old girl with incontinentia pigmenti and late-onset cerebral arteriopathy induced with IAV infection.Conclusion The etiology of IAV infection combined with acute hemiplegia is complex,and influenza-associated encephalopathy/encephalitis and cerebrovascular disease should be considered.Timely imaging examination and even a genetic test may be helpful for accurate diagnosis and effective intervention.IAV infection may trigger cerebral infarction in patients with CADASIL or moyamoya disease,as well as delayed intracerebral hemorrhage in children with incontinentia pigmenti.The possible mechanism may be attributed to tissue hypoperfusion,arterial stenosis,occlusion or hemorrhage caused by original vascular lesions and cytokines storm requiring for further studies.