Awaya Tomonari, Kato Takeo, Shibata Minoru, Yamanaka Yasunari, Nakahata Tatsutoshi
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Pediatr Neurol. 2008 Mar;38(3):218-20. doi: 10.1016/j.pediatrneurol.2007.10.010.
We present a 2-year-old patient who showed progressive widespread white-matter abnormalities on magnetic resonance imaging 1 month after viral encephalitis, despite her good clinical recovery. These lesions on magnetic resonance imaging had not responded to therapies commonly used to treat secondary immune-mediated demyelinating lesions, as observed in acute disseminated encephalomyelitis. Acute viral encephalitis caused cortical blindness, but no other clinical signs developed during her clinical course. The progressive white-matter lesion in our case was different from the exacerbation of viral encephalitis or secondary immune-mediated encephalitis. A year later, magnetic resonance imaging-demonstrated brain atrophy with cystic changes in the bilateral occipital area, with remarkably reduced white-matter lesions. We hypothesize that the progressive white-matter changes resulted from the process of atrophy, degeneration, and cystic formation after viral encephalitis, rather than from the immune-mediated demyelinating process.
我们报告一名2岁患者，其在病毒性脑炎1个月后磁共振成像显示进行性广泛的白质异常，尽管其临床恢复良好。如急性播散性脑脊髓炎中所见，这些磁共振成像上的病变对常用于治疗继发性免疫介导脱髓鞘病变的疗法无反应。急性病毒性脑炎导致皮质盲，但在其病程中未出现其他临床体征。我们病例中的进行性白质病变不同于病毒性脑炎或继发性免疫介导性脑炎的加重。一年后，磁共振成像显示双侧枕叶区域脑萎缩伴囊性改变，白质病变明显减少。我们推测，进行性白质改变是病毒性脑炎后萎缩、变性和囊性形成过程所致，而非免疫介导的脱髓鞘过程。
