Fujii Katsunori, Ikehara Hajime, Nagasawa Koo, Hishiki Haruka, Uchikawa Hideki, Shimojo Naoki
Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan.
Child Neurol Open. 2014 Aug 26;1(1):2329048X14544473. doi: 10.1177/2329048X14544473. eCollection 2014 Jul-Sep.
The anterior commissure is an evolutionarily conserved nerve bundle that connects the right and left hemispheres, playing pivotal neurological roles in visual, linguistic, and olfactory functions. The authors herein describe a 16-month-old boy with high fever, lethargy, and recurrent seizures. Polymerase chain reaction (PCR) examination detected human herpesvirus 6 (HHV-6) in both the cerebrospinal fluid and the pharyngeal swabs, leading to the diagnosis of HHV-6 encephalitis. Brain magnetic resonance imaging (MRI) 4 days after disease onset distinctly revealed anterior commissure involvement on diffusion-weighted images and apparent diffusion coefficient maps, suggesting that this lesion was cytotoxic edema. After treatment with 30 mg/kg/d methylprednisolone for 3 days, the anterior commissure involvement on MRI was completely diminished. This is the first MRI report rarely showing anterior commissure involvement in encephalitis, suggesting that this lesion might be caused by direct invasion of HHV-6 or transient axonal swelling associated with inferior temporal lobe damage.
前连合是一条在进化上保守的神经束，连接左右半球，在视觉、语言和嗅觉功能中发挥关键的神经学作用。本文作者描述了一名16个月大的男孩，他出现高热、嗜睡和反复癫痫发作。聚合酶链反应（PCR）检测在脑脊液和咽拭子中均发现了人疱疹病毒6型（HHV-6），从而诊断为HHV-6脑炎。发病4天后的脑磁共振成像（MRI）在扩散加权图像和表观扩散系数图上清晰显示前连合受累，提示该病变为细胞毒性水肿。用30mg/kg/d甲基强的松龙治疗3天后，MRI上的前连合受累完全消失。这是第一份关于脑炎中罕见的前连合受累的MRI报告，提示该病变可能是由HHV-6的直接侵袭或与颞下叶损伤相关的短暂轴突肿胀引起的。
