新生儿单纯疱疹病毒性脑炎临床与影像特征

Clinical and Imaging Features of Neonatal Herpes Simplex Encephalitis

目的总结新生儿单纯疱疹病毒性脑炎(NHSE)的临床及影像特点,提高对本病的认识。资料与方法回顾性分析2016年1月—2023年6月首都医科大学附属北京儿童医院确诊的5例NHSE患儿临床及影像学资料,5例患儿均行MRI平扫检查,其中3例同时行MRI增强检查,2例患儿接受过CT检查。观察病变累及部位、密度/信号特点、强化方式及复查时影像学变化等。结果NHSE患儿临床多表现为发热(5例)、惊厥(4例),部分可伴有皮肤疱疹(2例)。NHSE影像学多为双侧大脑半球内对称性(1例)或弥漫性/多灶性病变(4例),同时频繁累及双侧丘脑(5例)。早期CT检查可无异常(1例)或表现为大范围低密度灶(1例);MRI平扫显示急性期病变明显扩散受限(3例),MRI增强后受累部位柔脑膜明显强化(3例)。颅内病变最终常造成患儿脑实质弥漫性萎缩、形成多囊性脑软化(3例),预后不佳。结论NHSE临床表现缺乏特异性,尽早进行MRI检查对明确诊断及评估病情具有重要价值。

Purpose To summarize the clinical and imaging features of neonatal herpes simplex encephalitis(NHSE).Materials and Methods Clinical and imaging data of 5 NHSE from January 2016 to June 2023 in Beijing Children's Hospital,Capital Medical University were retrospectively collected.All five children underwent MRI examinations,with three of them undergoing enhanced scanning simultaneously.Two children had previously undergone CT scans.The location,density/signal,enhancement characteristics as well as followup imaging changes of the lesions were reviewed.Results The main clinical manifestations of NHSE were fever(5 cases)and seizure(4 cases),sometimes accompanied by herpes(2 cases).Imaging examinations in NHSE typically presented with symmetric(1 case)or diffuse/multifocal(4 cases)lesions in bilateral cerebral hemispheres,along with involvement of the bilateral thalamus(5 cases).Early CT scans showed either no abnormalities(1 case)or extensive areas of low density(1 case).MRI examinations usually demonstrated restricted diffusion of acute phase lesions(3 cases)and significant leptomeningeal enhancement in affected areas(3 cases).Intracranial lesions often led to the diffuse atrophy of brain parenchyma and polycystic encephalomalacia(3 cases),indicating a poor prognosis.Conclusion The clinical manifestations of NHSE are nonspecific.Early MRI examinations are of great value for accurate diagnosis and disease evaluation.