Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelung and Linkou, Chang Gung University College of Medicine, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.
Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Neuroradiology. 2023 Jul;65(7):1179-1181. doi: 10.1007/s00234-023-03160-7. Epub 2023 May 18.
We present a pediatric case of acute hemorrhagic leukoencephalitis associated with SARS-CoV-2 Omicron BA 2.0 infection. A previously healthy girl presented with ataxia and diplopia three weeks after the COVID-19 confirmation from a nasopharyngeal swab. Acute and symmetrical motor weakness and drowsiness ensued within the following 3 days. She then became spastic tetraplegic. MRI revealed multifocal lesions in the cerebral white matter, basal ganglia, and brainstem, with hemorrhagic changes confirmed with T1-hyperintensity and hypointensity on susceptibility-weighted images. Peripheral areas of decreased diffusion, increased blood flow, and rim contrast enhancement were noted in the majority of lesions. She was treated with a combination of intravenous immunoglobulin and methylprednisolone pulse therapy. Neurological deterioration ensued with coma, ataxic respiratory pattern and decerebrate posture. Repeated MRI performed on day 31 revealed progression of abnormalities, hemorrhages and brain herniation. Despite the administration of plasma exchange, she died two months after admission.
我们报告了一例与 SARS-CoV-2 奥密克戎 BA 2.0 感染相关的急性出血性脑白质炎的儿科病例。一名既往健康的女孩在鼻咽拭子检测出 COVID-19 阳性后 3 周出现共济失调和复视。随后的 3 天内，她出现了急性、对称性的四肢无力和嗜睡。继而发展为痉挛性四肢瘫痪。MRI 显示大脑白质、基底节和脑干存在多灶性病变，T1 高信号和磁敏感加权成像低信号证实存在出血性改变。大多数病变中均可见弥散受限的周边区域、血流增加和边缘对比增强。她接受了静脉注射免疫球蛋白和甲基强的松龙脉冲治疗的联合治疗。随后出现了神经恶化，表现为昏迷、共济失调性呼吸模式和去脑强直体位。第 31 天重复 MRI 显示异常、出血和脑疝进展。尽管进行了血浆置换，她还是在入院后 2 个月死亡。
