Hazama Kyoko, Shiihara Takashi, Tsukagoshi Hiroyuki, Matsushige Takeshi, 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. 2019 Jun;41(6):551-554. doi: 10.1016/j.braindev.2019.02.014. Epub 2019 Mar 6.
Rhinovirus is a common respiratory pathogen for children throughout the year; nevertheless, its central nervous system involvement is extremely rare, and only two cases have been reported to date: meningitis and sepsis-like illness.
A previously healthy 2-year-old Japanese boy developed fever, followed by seizures and lethargy. His cerebrospinal fluid cell count and protein level were slightly increased; brain magnetic resonance imaging showed abnormal intensities in the bilateral cerebellar dentate nuclei, which were prominent in diffusion-weighted images. After his consciousness disturbance improved, cerebellar dysfunction became apparent. He was treated symptomatically, without steroids or any other immunosuppressants. He almost recovered within a few months; however, cerebellar atrophy became evident on brain magnetic resonance imaging. Using acute specimens, human rhinovirus A was detected in his throat swab and cerebrospinal fluid.
Acute cerebellitis, in which cerebellar inflammation is predominant, is occasionally accompanied by cerebral symptoms, such as consciousness disturbance and seizures. As a causative pathogen, rotavirus is the most common; however, rhinovirus-associated acute encephalitis/encephalopathy and concurrent cerebellitis have not been reported before. Further research, using recent molecular techniques to detect various central nervous system pathogens, including rhinovirus, is needed to delineate the underlying pathophysiology.
鼻病毒是儿童全年常见的呼吸道病原体；然而，其累及中枢神经系统极为罕见，迄今为止仅报道过两例：脑膜炎和类败血症样疾病。
一名既往健康的2岁日本男孩出现发热，随后出现惊厥和嗜睡。他的脑脊液细胞计数和蛋白水平略有升高；脑磁共振成像显示双侧小脑齿状核有异常信号，在弥散加权图像中更为明显。在其意识障碍改善后，小脑功能障碍变得明显。他接受了对症治疗，未使用类固醇或任何其他免疫抑制剂。他在几个月内基本康复；然而，脑磁共振成像显示小脑萎缩明显。在急性期标本中，在他的咽拭子和脑脊液中检测到人类鼻病毒A。
以小脑炎症为主的急性小脑炎偶尔会伴有意识障碍和惊厥等脑部症状。作为致病病原体，轮状病毒最为常见；然而，此前尚未报道过鼻病毒相关的急性脑炎/脑病并发小脑炎。需要使用最新的分子技术检测包括鼻病毒在内的各种中枢神经系统病原体进行进一步研究，以阐明潜在的病理生理学机制。
