Maloney J A, Mirsky D M, Messacar K, Dominguez S R, Schreiner T, Stence N V
From the Departments of Radiology (J.A.M., D.M.M., N.V.S.)
From the Departments of Radiology (J.A.M., D.M.M., N.V.S.).
AJNR Am J Neuroradiol. 2015 Feb;36(2):245-50. doi: 10.3174/ajnr.A4188. Epub 2014 Nov 20.
Enterovirus D68 was responsible for widespread outbreaks of respiratory illness throughout the United States in August and September 2014. During this time, several patients presented to our institution with acute flaccid paralysis and cranial nerve dysfunction. The purpose of this report is to describe the unique imaging findings of this neurologic syndrome occurring during an enterovirus D68 outbreak.
Patients meeting a specific case definition of acute flaccid paralysis and/or cranial nerve dysfunction and presenting to our institution during the study period were included. All patients underwent routine MR imaging of the brain and/or spinal cord, including multiplanar T1, T2, and contrast-enhanced T1-weighted imaging.
Eleven patients met the inclusion criteria and underwent MR imaging of the brain and/or spinal cord. Nine patients presented with brain stem lesions, most commonly involving the pontine tegmentum, with bilateral facial nerve enhancement in 1 patient. Ten patients had longitudinally extensive spinal cord lesions; those imaged acutely demonstrated involvement of the entire central gray matter, and those imaged subacutely showed lesions restricted to the anterior horn cells. Ventral cauda equina nerve roots enhanced in 4 patients, and ventral cervical nerve roots enhanced in 3, both only in the subacute setting.
Patients presenting with acute flaccid paralysis and/or cranial nerve dysfunction during the recent enterovirus D68 outbreak demonstrate unique imaging findings characterized by brain stem and gray matter spinal cord lesions, similar to the neuroimaging findings described in previous outbreaks of viral myelitis such as enterovirus 71 and poliomyelitis.
2014年8月和9月，肠道病毒D68在美国引发了广泛的呼吸道疾病疫情。在此期间，数名患者因急性弛缓性麻痹和颅神经功能障碍前来我院就诊。本报告旨在描述在肠道病毒D68疫情期间发生的这种神经综合征的独特影像学表现。
纳入在研究期间因急性弛缓性麻痹和/或颅神经功能障碍符合特定病例定义并前来我院就诊的患者。所有患者均接受了脑部和/或脊髓的常规磁共振成像检查，包括多平面T1、T2加权成像以及增强T1加权成像。
11名患者符合纳入标准并接受了脑部和/或脊髓的磁共振成像检查。9名患者出现脑干病变，最常见于脑桥被盖部，1名患者双侧面神经强化。10名患者有纵向广泛的脊髓病变；急性期成像的患者显示整个中央灰质受累，亚急性期成像的患者显示病变局限于前角细胞。4名患者的腹侧马尾神经根强化，3名患者的腹侧颈神经根强化，均仅在亚急性期出现。
在近期肠道病毒D68疫情期间出现急性弛缓性麻痹和/或颅神经功能障碍的患者表现出独特的影像学表现，其特征为脑干和脊髓灰质病变，类似于先前肠道病毒71和脊髓灰质炎等病毒性脊髓炎疫情中所描述的神经影像学表现。
