Hung K L, Liao H T, Tsai M L
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, ROC.
J Child Neurol. 2000 Oct;15(10):666-70. doi: 10.1177/088307380001501005.
Fifty cases of postinfectious encephalomyelitis admitted to our Pediatric Department during the period 1980 to 1997 were consecutively collected and reviewed. There were 28 males and 22 females. The age of onset ranged from 9 months to 14 years. The antecedent infections included measles (6 cases), rubella (5 cases), mumps (4 cases), chicken pox (4 cases), Epstein-Barr virus infection (11 cases), mycoplasma infection (6 cases), and unknown etiology (14 cases). The cessation of measles, rubella, and mumps as causes for encephalomyelitis in our patients corresponds with the introduction of a measles-mumps-rubella nationwide vaccination program in Taiwan commencing in 1992. The main clinical symptoms were fever, headache, and/or vomiting, seizure, and motor weakness. The presenting signs included altered consciousness, meningeal signs, cranial nerve palsy, brainstem signs, involuntary movement, and cerebellar signs. Computed tomography scans were abnormal for 14 (56%) of 25 patients studied, whereas magnetic resonance imaging (MRI) disclosed lesions in 14 (82%) of 17 patients, with abnormal signals in various parts of the cerebral hemisphere, as well as in the basal ganglion, diencephalon, midbrain, brain stem, and cerebellum. Of the three patients with negative MRI findings, an abnormal finding on somatosensory evoked potential was noted for one patient, and a focal decrease in tracer uptake on single photon emission computed tomography (SPECT) was found for the other two patients. This study demonstrates that the causative agents of postinfectious encephalomyelitis in Taiwan have changed from those of traditional exanthematous diseases to nonspecific respiratory infections and suggests that this may also be the case in other parts of the world. MRI remains the imaging method of choice, whereas other neurofunctional studies such as evoked potentials and SPECT are complementary for the diagnosis.
我们连续收集并回顾了1980年至1997年期间收治于我院儿科的50例感染后性脑脊髓炎病例。其中男性28例，女性22例。发病年龄为9个月至14岁。前驱感染包括麻疹（6例）、风疹（5例）、腮腺炎（4例）、水痘（4例）、EB病毒感染（11例）、支原体感染（6例）以及病因不明（14例）。在我们的患者中，麻疹、风疹和腮腺炎作为脑脊髓炎病因的情况减少，这与1992年台湾开始实施的全国性麻疹-腮腺炎-风疹疫苗接种计划相符合。主要临床症状为发热、头痛和/或呕吐、惊厥以及运动无力。体征包括意识改变、脑膜刺激征、脑神经麻痹、脑干体征、不自主运动以及小脑体征。25例接受计算机断层扫描（CT）检查的患者中有14例（56%）结果异常，而17例接受磁共振成像（MRI）检查的患者中有14例（82%）发现病变，病变位于大脑半球各部位以及基底节、间脑、中脑、脑干和小脑。在3例MRI检查结果为阴性的患者中，1例体感诱发电位检查有异常发现，另外2例单光子发射计算机断层扫描（SPECT）检查发现示踪剂摄取局部减少。本研究表明，台湾感染后性脑脊髓炎的病原体已从传统的出疹性疾病转变为非特异性呼吸道感染，并且提示世界其他地区可能也存在这种情况。MRI仍然是首选的成像方法，而诱发电位和SPECT等其他神经功能检查对诊断具有辅助作用。
