重症手足口病并脑干脑炎的MRI表现及临床特征  

Magnetic Resonance Imaging and Clinical Features of Severe Hand-Foot-Mouth Disease Complicated with Brainstem Encephalitis

作　　者：黎加识[1] 张礼鹃[1] 涂昌灼[1] 吴光任[1] 张伟娜[1] 

机构地区：[1]东莞市虎门医院磁共振室,广东东莞523902

出　　处：《实用儿科临床杂志》2011年第6期430-432,435,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨重症手足口病并脑干脑炎的MRI表现及临床特征。方法收集2010年3-5月确诊为手足口病并脑干脑炎的患儿29例,对其MRI与临床资料进行回顾性分析。结果 29例患儿MRI表现:阴性25例,阳性4例,病灶均局限在脑桥和延脑交界部,2例病灶为脑桥、延脑交界处对称性向两侧延伸,2例病灶非对称性向两侧延伸。信号特征均呈斑片状T1加权像(T1WI)略低信号、T2加权像(T2WI)略高信号,边界不清。随访10 d^2个月,脑桥和延脑交界部病灶逐渐变小,长T1、长T2信号改变更显著,边界逐渐清晰。临床特征:29例患儿均有发热和皮疹;神经系统症状中,肢体震颤29例(100%),眼球运动异常(游动或上翻)23例(79.3%),烦躁和惊恐16例(55.2%),行走不稳12例(41.4%);MRI阳性4例患儿有神经系统后遗症,25例阴性患儿无神经系统后遗症。结论重症手足口病并脑干脑炎的MRI与临床表现具有一定关系,MRI能真实显示其脑干脑炎脑部受损情况及病变发展变化,能为临床诊断、治疗及预后提供可靠的影像学依据。Objective To explore the magnetic resonance imaging（MRI） and clinical features of severe hand-foot-mouth disease（HFMD） complicated with brainstem encephalitis.MethodsThe clinical data of 29 children diagnosed as HFMD complicated with brainstem encephalitis from Mar.to May 2010 were collected.The MRI and clinical data were retrospectively analyzed.ResultsMRI showed that 25 cases were negative,but 4 cases were positive.The lesions in 4 positive cases were located in the junction of the pons and medulla oblongata,of which 2 cases extended bilaterally symmetrical,and 2 cases extended asymmetric.All lesions demonstrated slightly low signal on patchy T1-weighted images（T1WI）,and slightly high signal on T2WI,and the margin was not distinct.The 4 positive cases were followed-up for 10 days to 2 months.The lesions of the junction of the pons and medulla oblongata gradually decreased,and the change of long T1 and long T2 signals became more obvious,while the margins became distinct gradually.All the 29 cases had fever and rash.The neurological symptoms were prevalent,including 29 cases of limb tremor（100%）,23 cases of abnormality of eye movements（ocular drift or superduction）（79.3%）,16 cases of irritabi-lity and panic（55.2%）,and 12 cases of walking instability（41.4%）.The 4 positive cases of MRI did not have nervous system sequelae and 25 cases with negative of MRI without neurological sequelae when being discharged from hospital.ConclusionsMRI and clinical features showed certain characteristics in severe HFMD complicated with brainstem encephalitis.MRI can truly shows its brain damage and pathological changes,and provide reliable imaging basis for clinical diagnosis,treatment and prognosis.J Appl Clin Pediatr,2011,26（6）： 430-432

关 键 词：手足口病 脑干脑炎 磁共振成像 临床特征 儿童 

分 类 号：R725.1[医药卫生—儿科] R445.2[医药卫生—临床医学]