Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Eur J Pediatr. 2010 Oct;169(10):1287-91. doi: 10.1007/s00431-010-1202-y. Epub 2010 May 12.
Rotavirus, one of the major causes of severe gastroenteritis in children, occasionally causes central nervous system complications. Recently several patients with acute encephalitis/encephalopathy due to rotavirus associated with cerebellar signs and symptoms have been reported. The condition is characterized by disturbances of consciousness at onset and cerebellar signs and symptoms such as hypotonia, ataxia, dysmetria, and speech disorders, including mutism, slow speech, and dysarthria at convalescence. We report two patients (3-year-old girl, 2-year-old boy) who developed acute encephalitis due to rotavirus and showed cerebellar signs and symptoms. Both patients had characteristic history of consciousness disturbances subsequent to several days of diarrhea, vomiting and fever, and cerebellar symptoms such as hypotonia, ataxia, dysmetria, and speech disorders during the recovery period. Electroencephalography showed diffuse high-voltage delta wave activity in each patient. Brain magnetic resonance imaging showed cerebellar edema in the acute phase followed by cerebellar atrophy on follow-up images in both patients. In the first patient, diffusion-weighted images (DWI) revealed high signals at the left cerebellar peduncle region and apparent diffusion coefficient (ADC) maps showed decreased ADC values of the lesion in the acute phase. The first patient had dysmetria at 1-year follow-up. However, she had normal motor and cognitive functions and could lead her daily life without impairment. In the second patient, no further symptoms were apparent at 1-year follow-up. Acute encephalitis/encephalopathy due to rotavirus with cerebellar signs and symptoms might be diagnosed on DWI, by demonstrating decreased ADC values in acute phase.
轮状病毒是导致儿童严重肠胃炎的主要原因之一，偶尔会引起中枢神经系统并发症。最近，有几例因轮状病毒相关小脑症状和体征而引起的急性脑炎/脑病的患者被报道。这种疾病的特征是在发病时出现意识障碍，以及小脑症状和体征，如张力减退、共济失调、运动失调和言语障碍，包括缄默、言语缓慢和构音障碍在恢复期。我们报告了两名因轮状病毒引起急性脑炎并出现小脑症状和体征的患者（3 岁女孩，2 岁男孩）。这两名患者均有特征性的意识障碍病史，随后出现腹泻、呕吐和发热数天，恢复期出现小脑症状，如张力减退、共济失调、运动失调和言语障碍。脑电图显示每位患者均有弥漫性高电压 delta 波活动。脑磁共振成像显示急性期小脑水肿，随后在随访图像中均显示小脑萎缩。在第一个患者中，弥散加权成像（DWI）显示左小脑脚区域的高信号，在急性期表观扩散系数（ADC）图显示病变的 ADC 值降低。该患者在 1 年随访时出现运动失调。然而，她的运动和认知功能正常，能够独立生活，没有任何障碍。在第二个患者中，1 年随访时没有出现进一步的症状。轮状病毒引起的急性脑炎/脑病伴小脑症状和体征可能通过 DWI 诊断，急性期显示 ADC 值降低。
