Kashiwagi Mitsuru, Tanabe Takuya, Shichiri Mototada, Tamai Hiroshi
Division of Pediatrics, Hirakata Municipal Hospital, Hirakata, Osaka.
No To Hattatsu. 2003 Jul;35(4):310-5.
Children who present delirium associated with high fever may develop with encephalitis or encephalopathy, especially in influenza infection. The aim of this study is to differentiate the patients with the central nervous infection or with the parasomnias from benign transient delirium in patients who visit the emergency room complaining of illusions. Ten patients aged from 2 to 7 years were enrolled in this study. There were 2 patients with central nervous infection, one with encephalo-myelitis due to mycoplasma infection and one with acute necrotizing encephalopathy due to influenza infection. The remaining 8 patients had benign delirium associated with high fever which disappeared in a self-limiting manner. Three patients had a febrile seizure (FS) and 4 patients had family history of FS. The points to differentiate the delirium with parasomnias from benign type is fearful expression, positive past history, autonomic nerve symptoms. Delirium consisted of visual hallucination, and occurred in association with sleep except in the patients with encephalopathy who became delirious when they were awake. Abnormal neurological findings such as meningeal signs and disturbed consciousness, appearance of delirium in the waking state, and marked slowing in the EEG background activity were considered to be warning factors useful in differentiating the benign type from the delirium with central nervous infection.
出现与高热相关谵妄的儿童可能会发展为脑炎或脑病，尤其是在流感感染时。本研究的目的是将因幻觉而到急诊室就诊的患者中患有中枢神经感染或异态睡眠的患者与良性短暂谵妄区分开来。本研究纳入了10名年龄在2至7岁的患者。有2例中枢神经感染患者，1例因支原体感染导致脑脊髓炎，1例因流感感染导致急性坏死性脑病。其余8例患者患有与高热相关的良性谵妄，呈自限性消失。3例患者有热性惊厥（FS），4例患者有FS家族史。将伴有异态睡眠的谵妄与良性类型区分开来的要点是恐惧表情、既往史阳性、自主神经症状。谵妄包括视幻觉，除了脑病患者在清醒时出现谵妄外，谵妄均与睡眠相关。异常的神经系统表现如脑膜刺激征和意识障碍、清醒状态下出现谵妄以及脑电图背景活动明显减慢被认为是有助于将良性类型与中枢神经感染所致谵妄区分开来的警示因素。
