Arai Hiromi, Goto Tomohide, Kimura Naoko, Miyama Sahoko
Department of Neurology, Tokyo Metropolitan Kiyose Children's Hospital, Tokyo.
No To Hattatsu. 2013 Nov;45(6):457-60.
A 8-year-old girl was hospitalized with consciousness disturbance and involuntary movements five days after the onset of fever. Cranial MRI revealed symmetrical involvement of the bilateral basal ganglia with elevated ADC mapping, suggesting vasogenic edema.Her clinical symptoms improved with methylprednisolone pulse therapy without neurological sequelae. The rapid antigen test for group A beta-hemolytic streptococcus was positive and serum ASO was elevated. Myelin basic protein in cerebrospinal fluid was elevated. We suggest that the pathophysiological mechanism in the present case was not necrotic/cytotoxic but autoimmune inflammation, which is compatible with acute disseminated encephalomyelitis associated with streptococcal infection.
一名8岁女孩在发热起病5天后因意识障碍和不自主运动入院。头颅MRI显示双侧基底节对称受累，表观扩散系数图升高，提示血管源性水肿。她的临床症状经甲泼尼龙冲击治疗后改善，无神经后遗症。A组β溶血性链球菌快速抗原检测呈阳性，血清抗链球菌溶血素O升高。脑脊液中髓鞘碱性蛋白升高。我们认为本例的病理生理机制不是坏死/细胞毒性，而是自身免疫性炎症，这与链球菌感染相关的急性播散性脑脊髓炎相符。
