Rosés-Noguer F, Raspall-Chaure M, Macaya-Ruiz A, del Toro-Riera M, Vázquez-Méndez E, Roig-Quilis M
Servicio de Neurología Pediátrica, Hospital Universitari Materno-Infantil de la Vall d'Hebron, Barcelona, Spain.
Rev Neurol. 2006;42(8):466-70.
Acute cerebellitis is an uncommon complication following Mycoplasma pneumoniae infection. A benign and self-limited course has been described in the few reports found of this association.
We report two patients with an apparently M. pneumoniae-induced acute cerebellitis that resulted in cerebellar atrophy. Patients presented with a cerebellar syndrome including ataxia, hypotonia, dysarthric speech and dysmetria, which were preceded by signs of respiratory infection. Initial brain magnetic resonance imaging (MRI) in case 1 was normal but in case 2 it displayed striking cerebellar swelling, small fourth ventricle and supratentorial ventriculomegaly which was self-limited and did not require neurosurgical intervention. Serological studies confirmed a recent M. pneumoniae infection. Case 1 has followed an unfavourable clinical course, with incomplete resolution of cerebellar dysfunction, while case 2 has remained asymptomatic. Follow-up brain MRI have demonstrated prominent cerebellar atrophy in both patients.
M. pneumoniae infection should be considered in those patients with acute cerebellitis showing an incomplete resolution of cerebellar dysfunction or those who develop early cerebellar atrophy. The presenting MRI findings do not seem to predict final neurological outcome.
急性小脑炎是肺炎支原体感染后一种罕见的并发症。在已发现的关于这种关联的少数报告中描述了其良性且自限性的病程。
我们报告了两名患者，他们明显因肺炎支原体感染引发急性小脑炎，进而导致小脑萎缩。患者表现为小脑综合征，包括共济失调、肌张力减退、构音障碍和辨距不良，这些症状之前有呼吸道感染的迹象。病例1的初始脑部磁共振成像（MRI）正常，但病例2显示出明显的小脑肿胀、第四脑室狭小和幕上脑室扩大，这种情况是自限性的，无需神经外科干预。血清学研究证实近期有肺炎支原体感染。病例1的临床病程不利，小脑功能障碍未完全恢复，而病例2一直无症状。随访脑部MRI显示两名患者均有明显的小脑萎缩。
对于那些急性小脑炎患者，如果小脑功能障碍未完全恢复或出现早期小脑萎缩，应考虑肺炎支原体感染。目前的MRI表现似乎无法预测最终的神经学结局。
