Mastroyianni Sotiria D, Voudris Konstantinos A, Katsarou Efstathia, Gionnis Dimitrios, Mavromatis Panagiotis, Vagiakou Eleni A, Skardoutsou Angeliki
Department of Neurology, P&A Kyriakou Children's Hospital, Athens, Greece.
J Child Neurol. 2003 Aug;18(8):570-2. doi: 10.1177/08830738030180081301.
Acute necrotizing encephalopathy is a severe parainfectious disorder with a clear racial predilection for Oriental children living in the Far East. The prognosis was originally reported as grave; however, a mild form of the disease has recently been described. A case of parainfluenza virus-associated acute necrotizing encephalopathy in a Caucasian child with a mild clinical course and excellent prognosis is presented. In this patient, the initial clinical picture was not very impressive, and the diagnosis was delayed until the third week of the illness, when neuroimaging was performed. Two months later, clinical and neuroimaging findings had almost completely resolved. Suggested criteria for a benign prognosis, such as normal liver function and cerebrospinal fluid protein levels, asymmetric thalamic lesions, and no brainstem involvement, were relevant in the present case. An extended diagnostic work-up for metabolic, vascular, coagulation, and infectious diseases was negative apart from a seroconversion for parainfluenza virus. To our knowledge, this is the first reported case of acute necrotizing encephalopathy associated with parainfluenza virus infection. Acute necrotizing encephalopathy, especially in the mild form, might not be fully recognized and could be underdiagnosed in Europe, where the reported incidence of the syndrome is very low.
急性坏死性脑病是一种严重的感染后疾病，明显好发于居住在远东地区的东方儿童。最初报道的预后情况很严峻；然而，最近发现了该疾病的一种轻症形式。本文报告了一名患有副流感病毒相关急性坏死性脑病的白种儿童病例，其临床病程较轻，预后良好。该患者最初的临床表现并不十分典型，直到发病第三周进行神经影像学检查时才确诊。两个月后，临床和神经影像学表现几乎完全消失。提示预后良好的标准，如肝功能和脑脊液蛋白水平正常、丘脑病变不对称以及无脑干受累，在本病例中均适用。除了副流感病毒血清学转换外，针对代谢、血管、凝血和感染性疾病的广泛诊断检查均为阴性。据我们所知，这是首例报道的与副流感病毒感染相关的急性坏死性脑病病例。急性坏死性脑病，尤其是轻症形式，在欧洲可能未被充分认识且诊断不足，因为该综合征在欧洲的报道发病率很低。
