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病例报告:一名伴有孤立性神经精神特征和明显疟疾后神经综合征的青少年女孩。

Case Report: An Adolescent Girl with Isolated Neuropsychiatric Features and Apparent Post-Malaria Neurological Syndrome.

机构信息

Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India.

Pediatric Specialist, District Hospital, Jaipur, India.

出版信息

Am J Trop Med Hyg. 2020 May;102(5):1030-1032. doi: 10.4269/ajtmh.19-0791.

Abstract

The post-malaria neurological syndrome (PMNS) is an unusual and relatively underreported complication of malaria, which usually occurs after the resolution of acute febrile illness and the patient is free from parasitemia. The clinical spectrum of the PMNS varies from acute-onset cerebellar ataxia to significant encephalopathy with focal deficits resembling acute disseminated encephalomyelitis. Uncommon presentations of PMNS include Guillain-Barre syndrome, postural tremor, or even isolated neuropsychiatric features. Although in a significant proportion of PMNS cases clinical resolution occurs with conservative treatment only, corticosteroids have been used in an attempt to hasten recoveries. Here, we present a case of a 12-year-old girl with acute onset, isolated neuropsychiatric features, following malaria. Neuroimaging, clinical examination, and cerebrospinal fluid studies were within normal limits. The child recovered completely after treatment with methylprednisolone pulse therapy. This case report illustrates the need for creating awareness about this uncommon complication of malaria. In view of the uncommon complication, early diagnosis and prompt treatment might help in the early resolution of symptoms.

摘要

疟后神经综合征(PMNS)是一种罕见且相对报道较少的疟疾并发症,通常发生在急性发热性疾病缓解后且患者无寄生虫血症时。PMNS 的临床谱从急性发作的小脑共济失调到伴有局灶性缺陷的明显脑病,类似于急性播散性脑脊髓炎。PMNS 的不常见表现包括吉兰-巴雷综合征、姿势性震颤,甚至是孤立的神经精神特征。尽管在 PMNS 病例的很大一部分中,仅通过保守治疗即可临床缓解,但已使用皮质类固醇试图加速恢复。在这里,我们报告了一例 12 岁女孩在疟疾后急性发作、孤立性神经精神特征的病例。神经影像学、临床检查和脑脊液研究均在正常范围内。在接受甲基泼尼松龙脉冲治疗后,患儿完全康复。该病例报告说明了需要提高对这种罕见疟疾并发症的认识。鉴于这种罕见的并发症,早期诊断和及时治疗可能有助于早期缓解症状。

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本文引用的文献

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Rehabilitation of Severe Postmalaria Neurological Syndrome.严重疟疾后神经综合征的康复治疗
Am J Phys Med Rehabil. 2019 May;98(5):e47-e50. doi: 10.1097/PHM.0000000000001050.
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