以双侧丘脑损伤为主的病毒性脑炎临床转归与治疗分析  

Analysis of clinical outcome and treatment of viral encephalitis with bilateral thalamic damage

作　　者：王三梅[1] 孙静[1] 杨常栓[1] 朱丽娜[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院神经发育科,100700

出　　处：《中华实用儿科临床杂志》2016年第8期620-623,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨以侵袭丘脑为主的病毒性脑炎临床转归及治疗特点，以期改善预后。方法收集2012年9月至2013年6月头颅MRI提示双侧丘脑损伤的病毒性脑炎患儿12例，随诊2年。通过病史询问、查体、实验室及脑功能监测，对治疗和预后进行回顾性分析。结果12例均急骤起病，高热、昏迷、抽搐，恢复中出现谵妄、不自主运动多，4例（33．3％）病情有反复；6例（50．0％）需呼吸机辅助通气；急性期视频脑电图均呈弥散性慢波，4例（33．3％）出现癫痫持续状态，10例需长期口服抗癫痫药物，其中3例6个月减停、4例1年减停、3例2年仍需药物维持脑电图稳定；头颅MRI提示除丘脑内灰质损伤外，均存在白质脱髓鞘。12例应用甲泼尼龙冲击治疗，6例在急性期能有效促进病情逆转，耐受良好；6例在亚急性期应用，5例康复速度明显增快，1例意识有改善，最终放弃后死亡；病程3个月，8例（66．7％）大运动及吞咽功能恢复正常，3例单侧肢体运动障碍。随访2年，大运动正常11例，智力正常9例、轻度落后2例。结论以侵袭丘脑为主的病毒性脑炎病情进展快，演变过程有相对特异性；亚急性期再发白质脱髓鞘比率高；快速阻断炎性免疫是治疗关键，甲泼尼松冲击在控制病情中发挥重要作用；早期合理治疗，远期预后良好。Objective To investigate the clinical outcome and treatment characteristics of viral encephalitis with bilateral thalamic damage so as to improve its prognosis. Methods Twelve cases of viral encephalitis with bilate- ral thalamic damage were collected during September 2012 to June 2013 by head MRI. These cases were retrospectively studied with the data of medical history, physical examination, laboratory and brain function monitoring and treatment. The relationship between treatment and prognosis was studied during 2 years of follow - up. Results All patients began with the rapid onset, accompanied by fever, coma, and convulsions. Delirium and involuntary movement occurred during the recovery period. Six cases （50.0%） received ventilator assisted ventilation. In the acute phase, electroencephalogram （EEG） showed diffuse slow wave and 4 cases（33.3% ） had status epileptieus on EEG. Ten cases discharged from hospi- tal had long - term oral anti epileptic drugs, which lasted 6 months in 3 cases, 1 year in 4 cases, and 2 years in 3 cases for maintaining EEG stability. Head MRI indicated white matter demyelination besides the gray matter damage within the thalamus. All 12 patients underwent methylprednisolone impact treatment and 6 cases had effective reversal within 1 week of onset with better tolerance ,and the other 6 cases received treatment in subacute stage and 5 of them accelerated reco- very and 1 case had sense improvement, but died after giving up therapy. After 3 months courses, 8 cases （ 66.7% ） got gross motor and swallowing function recovered to normal, and 3 cases had left unilateral limb movement disorder. After 2 years of follow- up,ll cases had normal motor,intelligence returned to normal in 9 cases,and 2 cases had mild mental retardation. Conclusions Viral encephalitis complicated with bilateral thalamic damage is characterized by acute onset, serious manifestations,idiopathic progress;in the subacute stage it is most likely to develop white matter demyelination. The key to control th

关 键 词：丘脑 脑炎 病毒性 治疗 

分 类 号：R725.1[医药卫生—儿科]