Sahu Jitendra K, Sharma Suvasini, Kamate Mahesh, Kumar Atin, Gulati Sheffali, Kabra Madhulika, Kalra Veena
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
J Child Neurol. 2010 Mar;25(3):390-2. doi: 10.1177/0883073809338625. Epub 2009 Jul 25.
We report the case of a 7-month-old child who presented with regression of milestones, seizures, altered sensorium, and vomiting. An elder sibling had died of similar complaints. Lead encephalopathy was considered because of presence of microcytic hypochromic anemia and dense metaphyseal bands on wrist radiogram. Magnetic resonance imaging (MRI) of the brain revealed diffuse dysmyelination involving both periventricular and subcortical white matter. Such diffuse changes have not been described previously. The child's father was operating an illicit lead-acid battery manufacturing unit at home. The child was subjected to chelation therapy, which was accompanied by environmental exposure source modification. He showed significant improvement. Our case highlights the importance of taking a detailed occupational history and considering lead poisoning in the differential diagnosis of encephalopathy of unidentifiable cause.
我们报告了一名7个月大儿童的病例，该患儿出现发育里程碑倒退、癫痫发作、意识改变和呕吐。其年长的兄弟姐妹曾因类似症状死亡。由于存在小细胞低色素性贫血以及腕部X线片上出现致密的干骺端带，考虑为铅中毒性脑病。脑部磁共振成像（MRI）显示弥漫性脱髓鞘，累及脑室周围和皮质下白质。此前尚未描述过这种弥漫性改变。患儿的父亲在家中经营一家非法铅酸电池制造工厂。该患儿接受了螯合疗法，并对环境暴露源进行了整改。他有显著改善。我们的病例强调了详细询问职业史以及在不明原因脑病的鉴别诊断中考虑铅中毒的重要性。
