Hung K L, Liao H T, Tsai M L
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
Acta Paediatr Taiwan. 2000 May-Jun;41(3):140-6.
Fourteen children with Epstein-Barr virus (EBV) encephalitis admitted to our pediatric department during the period 1988 to 1998 were collected and reviewed to characterize the clinical, laboratory and neuroradiological findings. There were 7 boys and 7 girls. The age of onset ranged from 10 months to 14 years. Among them, 5 patients belonged to Alice in Wonderland syndrome, 5 were diagnosed as acute viral encephalitis, 1 presented with acute meningoencephalitis followed by cerebellitis, the remaining 3 cases attributed to acute disseminated encephalomyelitis. The main symptoms were fever (43%), seizure (36%), bizarre behavior (31%), headache (21%) and metamorphopsia (36%). The presenting signs included altered consciousness (50%), meningeal sign (14%), bulbar sign (14%), cerebellar sign (7%), and cranial nerve palsy (7%). Classic findings of infectious mononucleosis were obscure. The laboratory data showed the existence of atypical lymphocyte in only one case but positive serology for EBV infection in all patients. Pleocytosis was found in 3 (30%) of 10 patients examined. Eight (67%) of 12 patients had nonspecific electroencephalographic changes in the acute stage. Computed tomography (CT) scans were abnormal in 2 (40%) of 5 patients tested; while magnetic resonance image (MRI) disclosed lesions in 5 (56%) of 9 patients, with abnormal signals in various parts of the brain. Single photon emission computed tomography (SPECT) brain scan showed abnormal perfusion lesions in 3 (75%) of 4 patients studied. The results demonstrate the diversity of neurological manifestations of EBV encephalitis. EBV should be considered in any acute neurological illness of uncertain etiology in the pediatric population. While MRI remains the image of choice in EBV encephalitis, SPECT detects the abnormal perfusion more precisely in a substantial number of patients.
收集并回顾了1988年至1998年期间我院儿科收治的14例 Epstein-Barr病毒（EBV）脑炎患儿的临床、实验室及神经影像学表现。其中男7例，女7例。发病年龄为10个月至14岁。其中5例为爱丽丝梦游仙境综合征，5例诊断为急性病毒性脑炎，1例表现为急性脑膜脑炎后继发小脑炎，其余3例为急性播散性脑脊髓炎。主要症状为发热（43%）、惊厥（36%）、怪异行为（31%）、头痛（21%）和视物变形（36%）。主要体征包括意识改变（50%）、脑膜刺激征（14%）、延髓征（14%）、小脑征（7%）和脑神经麻痹（7%）。传染性单核细胞增多症的典型表现不明显。实验室检查仅1例发现异型淋巴细胞，但所有患者EBV感染血清学均为阳性。10例接受检查的患者中3例（30%）出现脑脊液细胞数增多。12例患者中有8例（67%）在急性期脑电图有非特异性改变。5例接受CT检查的患者中有2例（40%）异常；9例接受磁共振成像（MRI）检查的患者中有5例（56%）发现脑内有病变，大脑各部位信号异常。4例接受单光子发射计算机断层扫描（SPECT）脑扫描的患者中有3例（75%）显示灌注异常。结果表明EBV脑炎的神经表现具有多样性。对于儿科不明病因的急性神经系统疾病均应考虑EBV感染。虽然MRI仍是EBV脑炎的首选影像学检查，但SPECT能在相当数量的患者中更精确地检测到灌注异常。
