Hazama Kyoko, Shiihara Takashi, Tsukagoshi Hiroyuki, Hasegawa Shunji, Dowa Yuri, Watanabe Mio
Department of Neurology, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsu-machi, Shibukawa, Gunma 377-8577, Japan.
Department of Neurology, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsu-machi, Shibukawa, Gunma 377-8577, Japan.
Brain Dev. 2017 Oct;39(9):808-810. doi: 10.1016/j.braindev.2017.04.012. Epub 2017 May 10.
Mumps is a common childhood viral disease characterized by fever and swelling of the parotid gland. The prognosis is generally good, although some complications, such as encephalitis (0.1%), exist. Acute encephalopathy with biphasic seizures and late reduced diffusion is the most common type of acute encephalopathy. However, this type of encephalopathy has not been reported in association with mumps infection.
A previously healthy 3-year-old Japanese boy had a brief convulsion after fever for 3days, and then had conscious disturbance and parotitis. After several days, he had a second brief convulsion and was admitted. Increased serum amylase levels and presence of anti-mumps immunoglobulin M antibody confirmed mumps parotitis. The patient had another brief seizure later the day of admission. He did not have status or cluster seizures, although the biphasic nature of his seizures, conscious disturbance between the seizures, no pleocytosis in cerebrospinal fluid, and brain magnetic resonance images were consistent with acute encephalopathy with biphasic seizures and late reduced diffusion.
In Japan, the mumps vaccine is not administered as a part of routine immunizations. It thus has low coverage (30-40%), and as a result, mumps infections are still common. However, this is the first case of mumps-related acute encephalopathy with biphasic seizures and late reduced diffusion. This case may be representative of only a minority of patients with mumps-associated central nervous system involvement. Nevertheless, this diagnostic possibility may be considered. In order to prevent mumps-related complications, routine mumps vaccination might be warranted.
腮腺炎是一种常见的儿童病毒性疾病，其特征为发热和腮腺肿大。尽管存在一些并发症，如脑炎（0.1%），但总体预后良好。伴有双相性惊厥和后期弥散受限的急性脑病是最常见的急性脑病类型。然而，这种类型的脑病尚未见与腮腺炎感染相关的报道。
一名此前健康的3岁日本男孩在发热3天后出现短暂惊厥，随后出现意识障碍和腮腺炎。几天后，他再次出现短暂惊厥并入院。血清淀粉酶水平升高及抗腮腺炎免疫球蛋白M抗体阳性确诊为腮腺炎。患者在入院当天晚些时候又出现一次短暂惊厥。他没有癫痫持续状态或成串发作，尽管其惊厥的双相性、惊厥间期的意识障碍、脑脊液中无细胞增多以及脑磁共振成像结果与伴有双相性惊厥和后期弥散受限的急性脑病相符。
在日本，腮腺炎疫苗并非常规免疫接种的一部分。因此其接种覆盖率较低（30 - 40%），结果腮腺炎感染仍然很常见。然而，这是首例与腮腺炎相关的伴有双相性惊厥和后期弥散受限的急性脑病病例。该病例可能仅代表少数患有腮腺炎相关中枢神经系统受累的患者。尽管如此，仍可考虑这种诊断可能性。为预防与腮腺炎相关的并发症，可能有必要进行常规腮腺炎疫苗接种。
