Sakuma Hiroshi, Takanashi Jun-Ichi, Muramatsu Kazuhiro, Kondo Hidehito, Shiihara Takashi, Suzuki Motomasa, Okanari Kazuo, Kasai Mariko, Mitani Osamu, Nakazawa Tomoyuki, Omata Taku, Shimoda Konomi, Abe Yuichi, Maegaki Yoshihiro, Murayama Kei, Murofushi Yuka, Nagase Hiroaki, Okumura Akihisa, Sakai Yasunari, Tada Hiroko, Mizuguchi Masashi
Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Department of Pediatrics and Pediatric Neurology, Tokyo Women's Medical University Yachiyo Medical Center, Tokyo, Japan.
Front Neurosci. 2023 Feb 27;17:1085082. doi: 10.3389/fnins.2023.1085082. eCollection 2023.
To clarify whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection cause acute encephalopathy in children and which are the most common syndromes that cause them and what are the outcomes.
A nationwide web-based survey among all members of the Japanese Society of Child Neurology to identify pediatric patients aged < 18 years who developed acute encephalopathy in Japan between 1 January 2020 and 31 May 2022 associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction or antigen tests using pharyngeal swabs. Acute encephalopathy was defined as acute onset of impaired consciousness lasting > 24 h or an altered mental state; neurological symptoms arising within 2 weeks of onset of COVID-19 or multisystem inflammatory syndrome in children (MIS-C)/pediatric inflammatory multisystem syndrome (PIMS); evidence of SARS-CoV-2 infection; and reasonable exclusion of other diseases. Patients were divided into the known clinico-radiological acute encephalopathy syndrome group and unexplained or unclassifiable acute encephalopathy group. Outcomes were assessed by pediatric cerebral performance category (PCPC) score at hospital discharge.
Of the 3,802 society members, 217 representing institutions responded, and 39 patients with suspected acute encephalopathy were reported, of which 31 met inclusion criteria. Of these patients, 14 were diagnosed with known clinico-radiological acute encephalopathy syndromes, with acute encephalopathy with biphasic seizures and late reduced diffusion (five patients) being the most common. Five developed acute encephalopathy associated with MIS-C/PIMS. Among 31 patients, 9 (29.0%) had severe sequelae or died (PCPC ≥ 4). Two of three patients with encephalopathy with acute fulminant cerebral edema and two with hemorrhagic shock and encephalopathy syndrome died. The PCPC scores were higher in the known clinico-radiological acute encephalopathy syndrome group than in the unexplained or unclassifiable acute encephalopathy group ( < 0.01).
Acute encephalopathy related to SARS-CoV-2 infection was demonstrated to be more severe than that caused by other viruses in Japan. Acute encephalopathy syndromes characterized by specific neuroradiological findings was associated with poor clinical outcomes.
阐明严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染是否会导致儿童急性脑病，导致儿童急性脑病最常见的综合征有哪些，以及其预后情况。
在日本儿童神经学会的所有成员中开展一项全国性的网络调查，以确定2020年1月1日至2022年5月31日期间在日本出现急性脑病的18岁以下儿科患者，这些患者经聚合酶链反应或使用咽拭子的抗原检测确诊感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。急性脑病定义为意识障碍急性发作持续超过24小时或精神状态改变；在新冠病毒病（COVID-19）或儿童多系统炎症综合征（MIS-C）/儿科炎症多系统综合征（PIMS）发病后2周内出现的神经症状；SARS-CoV-2感染的证据；以及合理排除其他疾病。患者被分为已知临床-放射学急性脑病综合征组和不明原因或无法分类的急性脑病组。出院时通过儿科脑功能表现分类（PCPC）评分评估预后。
在3802名学会成员中，有217名代表机构做出回应，报告了39例疑似急性脑病患者，其中31例符合纳入标准。在这些患者中，14例被诊断为已知临床-放射学急性脑病综合征，其中双相性惊厥伴晚期弥散受限的急性脑病（5例）最为常见。5例出现与MIS-C/PIMS相关的急性脑病。在31例患者中，9例（29.0%）有严重后遗症或死亡（PCPC≥4）。3例急性暴发性脑水肿性脑病患者中有2例死亡，2例出血性休克和脑病综合征患者死亡。已知临床-放射学急性脑病综合征组的PCPC评分高于不明原因或无法分类的急性脑病组（<0.01）。
在日本，与SARS-CoV-2感染相关的急性脑病被证明比其他病毒引起的更严重。以特定神经影像学表现为特征的急性脑病综合征与不良临床预后相关。
