From the Department of Radiology.
Department of Infection, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.
Pediatr Infect Dis J. 2019 Feb;38(2):99-103. doi: 10.1097/INF.0000000000002041.
Brainstem encephalitis is the most common neurologic complication after enterovirus 71 infection. The involvement of brainstem, especially the dorsal medulla oblongata, can cause severe sequelae or death in children with enterovirus 71 infection. We aimed to determine the prevalence of dorsal medulla oblongata involvement in children with enterovirus 71-related brainstem encephalitis (EBE) by using conventional magnetic resonance imaging (MRI) and to evaluate the value of dorsal medulla oblongata involvement in outcome prediction.
Forty-six children with EBE were enrolled in the study. All subjects underwent a 1.5 Tesla MRI examination of the brain. The disease distribution and clinical data were collected. Dichotomized outcomes (good vs. poor) at longer than 6 months were available for 28 patients. Logistic regression was used to determine whether the MRI-confirmed dorsal medulla oblongata involvement resulted in improved clinical outcome prediction when compared with other location involvement.
Of the 46 patients, 35 had MRI evidence of dorsal medulla oblongata involvement, 32 had pons involvement, 10 had midbrain involvement and 7 had dentate nuclei involvement. Patients with dorsal medulla oblongata involvement or multiple area involvement were significantly more often in the poor outcome group than in the good outcome group. Logistic regression analysis showed that dorsal medulla oblongata involvement was the most significant single variable in outcome prediction (predictive accuracy, 90.5%), followed by multiple area involvement, age and initial Glasgow Coma Scale score.
Dorsal medulla oblongata involvement on conventional MRI correlated significantly with poor outcomes in EBE children, improved outcome prediction when compared with other clinical and disease location variables, and was most predictive when combined with multiple area involvement, Glasgow Coma Scale score and age.
脑干脑炎是肠道病毒 71 感染后最常见的神经并发症。脑干受累，特别是延髓背侧，可导致肠道病毒 71 感染患儿出现严重后遗症甚至死亡。本研究旨在通过常规磁共振成像（MRI）确定肠道病毒 71 相关脑干脑炎（EBE）患儿延髓背侧受累的发生率，并评估延髓背侧受累对预后的预测价值。
本研究纳入 46 例 EBE 患儿，所有患儿均行 1.5T 磁共振脑成像检查，收集疾病分布及临床资料。28 例患儿有 6 个月以上的随访结局（良好与不良）。采用逻辑回归分析比较 MRI 证实的延髓背侧受累与其他部位受累对临床结局预测的改善作用。
46 例患儿中，35 例 MRI 显示延髓背侧受累，32 例延髓与脑桥受累，10 例中脑受累，7 例齿状核受累。延髓背侧受累或多部位受累患儿更易出现不良结局。逻辑回归分析显示，延髓背侧受累是影响预后的最显著的单一因素（预测准确率为 90.5%），其次是多部位受累、年龄和初始格拉斯哥昏迷评分。
常规 MRI 显示延髓背侧受累与 EBE 患儿不良结局显著相关，与其他临床和疾病部位变量相比，能更好地预测预后，与多部位受累、格拉斯哥昏迷评分和年龄相结合时预测价值最高。
