新型冠状病毒相关副感染性脑病三例  

SARS-CoV-2 related to para-infectious encephalopathy:three cases report

作　　者：武进[1] 郝小军[1] 关鸿志[2] 郭雅坤 WU Jin;HAO Xiao-jun;GUAN Hong-zhi;GUO Ya-kun(Department of Neurology,The Ordos Central Hospital,Ordos 017000,Inner Mongolia,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Grade 2020,Department of Clinical Medicine,Inner Mongolia Medical University,Hohhot 010110,Inner Mongolia,China)

机构地区：[1]内蒙古自治区鄂尔多斯市中心医院神经内科,017000 [2]中国医学科学院北京协和医学院北京协和医院神经科,100730 [3]内蒙古医科大学临床医学系,呼和浩特010110

出　　处：《中国现代神经疾病杂志》2024年第4期238-244,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：北京协和医院中央高水平医院临床科研专项(项目编号:2022-PUMCH-B-120)。

摘　　要：研究背景副感染性脑病是一种继发于系统性感染性疾病的急性炎症性脑病,包括急性坏死性脑病和伴胼胝体压部可逆性病变的轻度脑炎/脑病(MERS)等亚型。本文报告内蒙古自治区鄂尔多斯市中心医院2022年12月至2023年2月诊断与治疗的3例新型冠状病毒相关副感染性脑病患者,并复习相关文献,总结疾病临床特征。方法与结果共3例新型冠状病毒相关副感染性脑病患者包括新型冠状病毒相关急性坏死性脑病2例和新型冠状病毒相关MERS 1例,均于发热后2~4 d出现意识障碍,以及失语、精神异常、抽搐发作等;新型冠状病毒咽拭子检测均呈阳性;头部MRI显示1例脑干和双侧丘脑对称性异常信号,1例双侧丘脑对称性异常信号,1例胼胝体压部异常信号;均予以激素冲击治疗和(或)静脉注射免疫球蛋白;1例死亡,2例痊愈。结论新型冠状病毒相关副感染性脑病包括新型冠状病毒相关急性坏死性脑病和MERS等临床亚型,前者进展迅速,病情较严重,病残率和病死率较高,预后较差;后者症状相对较轻微,预后较好。Background1 Para-infectious encephalopathy is an acute inflammatory encephalopathy secondary to a systemic infectious disease,including acute necrotizing encephalopathy(ANE)and mild encephalitis/encephalopathy with a reversible splenial lesion(MERS).This paper reports on 3 cases of SARS-CoV-2 related to para-infectious encephalopathy diagnosed and treated in The Ordos Central Hospital of Inner Mongolia Autonomous Region from December 2022 to February 2023,and reviews relevant literature to summarize the clinical characteristics of the disease.Methods and Results The 3 patients with SARS-CoV-2 related to para-infectious encephalopathy,including 2 cases of SARS-CoV-2 related to ANE and one case of SARS-CoV-2 related to MERS were reported.Three patients developed consciousness disorder 2-4 d after fever,and still had aphasia,mental abnormality,convulsions,etc..SARS-CoV-2 throat swab was positive.Head MRI showed one abnormal signal of brain stem and bilateral thalamus,one abnormal signal of bilateral thalamus,and one abnormal pressure of corpus callosum.All received hormone shock therapy and(or)intravenous immunoglobulin.One died,and 2 cases were recovered.Conclusions SARS-CoV-2 related to para-infectious encephalopathy including SARS-CoV-2 related to ANE and MERS and other clinical subtypes,the former has rapid progress,severe disease,high disability rate and fatality rate and poor prognosis,while the latter has relatively mild symptoms and better prognosis.

关 键 词：新型冠状病毒 脑炎 病毒性 磁共振成像 

分 类 号：R511[医药卫生—内科学] R747.9[医药卫生—临床医学]