患儿接种不同减毒活疫苗后发生复发性第 6 脑神经麻痹：病例报告。
Recurrent 6th nerve palsy in a child following different live attenuated vaccines: case report.
机构信息
Central Medical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.
出版信息
BMC Infect Dis. 2012 Apr 30;12:105. doi: 10.1186/1471-2334-12-105.
BACKGROUND
Recurrent benign 6th nerve palsy in the paediatric age group is uncommon, but has been described following viral and bacterial infections. It has also been temporally associated with immunization, but has not been previously described following two different live attenuated vaccines.
CASE PRESENTATION
A case is presented of a 12 month old Caucasian boy with recurrent benign 6th nerve palsy following measles-mumps-rubella and varicella vaccines, given on separate occasions with complete recovery following each episode. No alternate underlying etiology was identified despite extensive investigations and review.
CONCLUSIONS
The majority of benign 6th nerve palsies do not have a sinister cause and have an excellent prognosis, with recovery expected in most cases. The exact pathophysiology is unknown, although hypotheses including autoimmune mechanisms and direct viral invasion could explain the pathophysiology behind immunization related nerve palsies. It is important to rule out other aetiologies with thorough history, physical examination and investigations. There is limited information in the literature regarding the safety of a repeat dose of a live vaccine in this setting. Future immunizations should be considered on a case-by-case basis.
背景
儿科患者中反复发作的良性第 6 颅神经麻痹并不常见，但有报道称其与病毒和细菌感染有关。它也与免疫接种有关，但以前没有在接种两种不同的减毒活疫苗后发生过。
病例介绍
我们报告了 1 例 12 月龄白人男孩，在分别接种麻疹-腮腺炎-风疹和水痘疫苗后出现复发性良性第 6 颅神经麻痹，每次发作后均完全恢复。尽管进行了广泛的检查和评估，但未发现其他潜在病因。
结论
大多数良性第 6 颅神经麻痹没有险恶的病因，预后良好，大多数情况下可恢复。确切的病理生理学机制尚不清楚，尽管包括自身免疫机制和直接病毒侵袭在内的假说可以解释免疫接种相关神经麻痹的病理生理学机制。重要的是要通过详细的病史、体格检查和检查排除其他病因。在这种情况下，关于重复剂量使用减毒活疫苗安全性的文献信息有限。应根据具体情况考虑以后的免疫接种。
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