Nagai T, Yagishita A, Tsuchiya Y, Asamura S, Kurokawa H, Matsuo N
Department of Pediatrics, Tokyo Metropolitan Kiyose Children's Hospital, Japan.
Brain Dev. 1993 Jan-Feb;15(1):67-73. doi: 10.1016/0387-7604(93)90009-w.
In Reye encephalopathy, diffuse brain swelling is a well known CT finding, but focal CT lesions have not been documented. We report 2 children with Reye encephalopathy and 2 children with non-Reye encephalopathy both associated with influenza A virus infection in whom symmetrical low density lesions of the thalamus and brainstem were detected on CT. These symmetrical low density lesions were present in the acute phase and decreased in size within a few weeks in all, and are still seen 2 years later as clearly defined small round areas in 3 surviving patients. Paired influenza A virus titers in blood showed 4-fold or more increase in all. Myelin basic protein (MBP) in CSF was increased in 2 of the 3 subjects studied. Liver biopsy showed diffuse lipid droplet infiltration in 2, focal infiltration in 1, and normal morphology in 1. The above data suggest that the symmetrical low density lesions were associated with influenza A virus infection, most likely consisting of edema, demyelination, and necrosis. We suspect that there is a continuum of Reye syndrome and virus-associated encephalopathy with significant overlap.
在瑞氏脑病中，弥漫性脑肿胀是一种众所周知的CT表现，但局灶性CT病变尚未见诸报道。我们报告了2例患有瑞氏脑病的儿童以及2例患有非瑞氏脑病但均与甲型流感病毒感染相关的儿童，他们的CT检查均发现丘脑和脑干有对称性低密度病变。这些对称性低密度病变在急性期出现，数周内所有患儿的病变大小均减小，在3名存活患者中，2年后仍可见为清晰界定的小圆形区域。所有患儿血液中的甲型流感病毒滴度均呈4倍或更高倍数升高。在研究的3名受试者中，有2名脑脊液中的髓鞘碱性蛋白（MBP）升高。肝活检显示，2例有弥漫性脂滴浸润，1例有局灶性浸润，1例形态正常。上述数据表明，对称性低密度病变与甲型流感病毒感染有关，很可能由水肿、脱髓鞘和坏死组成。我们怀疑瑞氏综合征与病毒相关性脑病之间存在连续且有显著重叠的情况。
