Sheth K J, Swick H M, Haworth N
Ann Neurol. 1986 Jan;19(1):90-3. doi: 10.1002/ana.410190120.
Of 44 children with hemolytic-uremic syndrome seen at Milwaukee Children's Hospital, 15 (34%) had neurological involvement. This group contained 8 boys and 7 girls, with a mean age of 3 1/4 years. Twelve patients had seizure within 48 hours of admission. Seizures were associated with hypertension, fever, hyponatremia, or hypocalcemia. Other neurological symptoms included altered consciousness, behavioral changes, diplopia, and dizziness. Hemiparesis (4 patients), eye involvement (7 patients), decerebrate posturing (2 patients), and ataxia (1 patient) were present on physical examination. Cerebrospinal fluid examination showed increased protein in 4 of 11 patients. Electroencephalograms were abnormal in all 9 patients tested. Computed tomographic and radionuclide scans showed evidence of vascular abnormalities in 4 of the 14 patients studied. Complete neurological recovery occurred in only 6 of the 15 children, while the remaining 6 demonstrated residual hemiparesis, seizures, and cortical visual defect. In those children with neurological involvement, there was a higher incidence of residual hypertension (49% versus 11%), chronic renal damage (40% versus 3.5%), and death (28% versus 0%), suggesting that central nervous system involvement indicates severe hemolytic-uremic syndrome.
在密尔沃基儿童医院就诊的44例溶血尿毒综合征患儿中，15例（34%）有神经受累情况。该组有8名男孩和7名女孩，平均年龄为3 1/4岁。12例患者在入院后48小时内发生惊厥。惊厥与高血压、发热、低钠血症或低钙血症有关。其他神经症状包括意识改变、行为变化、复视和头晕。体格检查发现偏瘫（4例）、眼部受累（7例）、去大脑强直姿势（2例）和共济失调（1例）。脑脊液检查显示，11例患者中有4例蛋白升高。所有9例接受检查的患者脑电图均异常。计算机断层扫描和放射性核素扫描显示，14例接受研究的患者中有4例有血管异常迹象。15名儿童中只有6例神经功能完全恢复，其余6例有偏瘫、惊厥和皮质视觉缺陷残留。在那些有神经受累的儿童中，残留高血压（49%对11%）、慢性肾损害（40%对3.5%）和死亡（28%对0%）的发生率更高，这表明中枢神经系统受累提示严重的溶血尿毒综合征。
