Department of Pediatric Neurology, Ihsan Doğramaci Children's Hospital, Faculty of Medicine, Hacettepe University, Ankara.
Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
J Child Neurol. 2020 Jul;35(8):501-508. doi: 10.1177/0883073820911737.
To investigate etiology and prognostic significance of pontine tegmentum lesions accompanying a cluster of acute flaccid myelitis.
We retrospectively examined patients from 6 centers in Turkey who manifested encephalitis or myelitis associated with dorsal pontine lesions on magnetic resonance imaging (MRI) between July 2018 and February 2019.
Twenty-two patients were evaluated. Ten of 22 (45%) presented with acute paralysis and 12 of 22 (55%) with brainstem symptoms only. Reverse transcription polymerase chain reaction for enterovirus was positive in 2 patients' respiratory tract. Other etiologic factors were detected in 10 cases. On follow-up, patients presenting with symptoms of myelitis developed motor sequalae although spinal cord lesions on MRI resolved in 5 of 9 (55%). Encephalitic symptoms, present in 17 cases, recovered in 13 (76%), and brain MRI showed complete or near-complete resolution in 11 of 14 (78%).
Various etiologic agents can be detected in patients with pontine involvement, even in a series collected during an outbreak of EV-D68. Encephalitis has a fair outcome but clinical recovery is slow and motor sequalae are frequent in spinal involvement, irrespective of follow-up spinal MRI findings.
探讨伴有急性弛缓性脊髓炎簇集的脑桥被盖病变的病因和预后意义。
我们回顾性检查了 2018 年 7 月至 2019 年 2 月期间土耳其 6 个中心的患者，这些患者在磁共振成像（MRI）上表现出脑炎或伴有背侧脑桥病变的脊髓炎。
对 22 名患者进行了评估。22 名患者中有 10 名（45%）表现为急性瘫痪，12 名（55%）仅表现为脑干症状。2 名患者呼吸道的逆转录聚合酶链反应检测出肠道病毒阳性。10 例患者检测到其他病因因素。随访时，出现脊髓炎症状的患者出现运动后遗症，尽管 9 例中的 5 例（55%）脊髓 MRI 上的脊髓病变已缓解。17 例存在脑炎症状，13 例（76%）恢复，14 例中的 11 例（78%）脑 MRI 显示完全或接近完全缓解。
即使在 EV-D68 爆发期间收集的一系列研究中，也可以检测到伴有脑桥受累的患者存在各种病因。脑炎的预后良好，但临床恢复缓慢，脊髓受累时经常出现运动后遗症，与随访脊髓 MRI 结果无关。
