Fang Qiong, Chen Lang, Chen Qiaobin, Lin Zhi, Yang Fang
Department of Pediatrics, Fujian Provincial Hospital, Provincial Clinical Medical College Affiliated to Fujian Medical University, 134 East Street, Fuzhou, Fujian 350001, PR China.
Brain Dev. 2017 Apr;39(4):321-326. doi: 10.1016/j.braindev.2016.10.009. Epub 2016 Nov 4.
To investigate the characteristics and etiology of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in Chinese children.
We collected ten pediatric MERS patients from local hospital and enrolled another nineteen patients by reviewing the available literatures. The information of enrolled patients about clinical features, laboratory data, treatment strategies and prognoses were collected for further analysis.
A total of 29 children, the median age of twenty-nine patients was (4.09±3.64) years old. The male-to-female ratio was 1.42:1.0. The major cause of MERS was viral infection. 18 patients had consciousness disturbance which was the most prominent syndrome. 18 patients had transient seizures and only one needed anticonvulsant treatment for long. 9 patients were observed serum sodium levels <135mEq/L. The cells and protein of cerebral spinal fluid (CSF) were increased in 3 patients. In all patients, brain MRI evaluation revealed typical lesion in splenium of the corpus callosum (SCC). 5 patients had additional lesions involving the periventricular white matter or bilateral centrum semiovale diagnosed. 3 patients were treated with antivirus treatment because of virus infection. 7 patients received corticosteroid. 2 patients received intravenous IVIG. As a result, all patients had fully recovered without neurological residual.
The result of present study suggests that Chinese children with MERS might have favorable prognosis, although there is still no guideline for treatment.
探讨中国儿童伴可逆性胼胝体压部病变的轻度脑炎/脑病(MERS)的特点及病因。
我们从当地医院收集了10例儿科MERS患者,并通过查阅现有文献纳入了另外19例患者。收集纳入患者的临床特征、实验室数据、治疗策略及预后等信息进行进一步分析。
共29例儿童,29例患者的中位年龄为(4.09±3.64)岁。男女比例为1.42∶1.0。MERS的主要病因是病毒感染。18例患者有意识障碍,这是最突出的症状。18例患者有短暂性癫痫发作,只有1例需要长期抗惊厥治疗。9例患者血清钠水平<135mEq/L。3例患者脑脊液细胞数及蛋白升高。所有患者脑部MRI评估均显示胼胝体压部(SCC)有典型病变。5例患者还被诊断有侧脑室旁白质或双侧半卵圆中心的额外病变。3例因病毒感染接受抗病毒治疗。7例接受了糖皮质激素治疗。2例接受了静脉注射免疫球蛋白(IVIG)治疗。结果,所有患者均完全康复,无神经功能残留。
本研究结果表明,中国儿童MERS患者可能预后良好,尽管目前仍没有治疗指南。