Luna D, Williams C, Dulac O, Lebon P, Ponsot G, Plouin P, Reinert P
Clinique de Pédiatrie et de Puériculture, INSERM U29, Hôpital Saint-Vincent-de-Paul, Paris.
Arch Fr Pediatr. 1990 May;47(5):339-44.
Delayed acute encephalitis is a rare complication of measles that may occur either in immunodepressed patients or in patients without overt immunodepression. In the present series of 8 cases, diagnosis was made on CSF/serum measles antibody titre and/or intranuclear paramyxovirus nucleocapsides identified by electron microscopy in the central nervous system cells. The disease is characterized by the association of focal defects (monoparesis, hemiparesis, aphasia, a.s.o.) with periodic myoclonic jerks without major impairment of consciousness. The encephalitis lasted 2 to 4 weeks and 3 patients died. With the exception of 1 case, all the patients had severe sequelae after a follow-up of 1 to 9 years. The EEG showed diffuse polymorphous delta waves, with a predominance on the side opposite to the myoclonias and pseudoperiodic complexes in all cases. CT scan was abnormal in 4 of 6 cases, showing hypodense areas. Antiviral or immunogenic therapeutic trials were administered to 5 patients without clear improvement. Sensitive methods of antibody dosage seem to be useful for the early diagnosis of the disease.
迟发性急性脑炎是麻疹的一种罕见并发症，可发生于免疫功能低下的患者或无明显免疫抑制的患者。在本系列8例病例中，根据脑脊液/血清麻疹抗体滴度和/或通过电子显微镜在中枢神经系统细胞中鉴定出的核内副粘病毒核衣壳做出诊断。该疾病的特征是局灶性缺陷（单瘫、偏瘫、失语等）与周期性肌阵挛性抽搐相关，而意识无重大损害。脑炎持续2至4周，3例患者死亡。除1例病例外，所有患者在1至9年的随访后均有严重后遗症。脑电图显示弥漫性多形性δ波，在所有病例中，以肌阵挛对侧为主，并伴有假周期性复合波。6例中有4例CT扫描异常，表现为低密度区。对5例患者进行了抗病毒或免疫原性治疗试验，但未见明显改善。敏感的抗体定量方法似乎对该疾病的早期诊断有用。
