Rotavirus-associated mild encephalopathy with a reversible splenial lesion (MERS)-case report and review of the literature.
Rotavirus-associated mild encephalopathy with a reversible splenial lesion (MERS)-case report and review of the literature.
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DOI：
10.1186/s12879-015-1192-5
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发表时间：
2015-10-24
影响因子：
3.7
通讯作者：
Prendergast AJ
中科院分区：
文献类型：
--
作者：
Karampatsas K;Spyridou C;Morrison IR;Tong CY;Prendergast AJ
轮状病毒是全世界5岁以下儿童严重胃肠炎的最常见原因。众所周知，轮状病毒可引起胃肠道以外的体征和症状，包括脑病等神经系统表现。轻度脑病伴可逆性脾损伤（MERS）是一种临床放射学综合征，与轮状病毒相关。我们报告一例4岁男孩临床轻度脑病，谁有一个孤立的胼胝体压病变的神经影像学，轮状病毒RNA检测粪便。我们利用这一情况作为一个机会，审查文献轮状病毒相关的MERS。一名先前健康的4岁男孩出现2天的呕吐、腹泻和发热史，并发意识水平降低。脑部磁共振成像显示胼胝体压部在T2和弥散加权图像上有明显的高信号。通过聚合酶链反应在粪便标本中检测到轮状病毒基因组，但在脑脊液中未检测到。基因型为G1P8。他的临床状况随着症状的逐渐消退而改善。出院时没有明显的神经系统并发症，2个月后随访时，患者没有复发症状或明显的残留缺陷。MERS是一种新的临床放射学综合征，首先在日本被描述。主要诊断特征为弥漫性低信号的短暂性脾损害。轮状病毒是与MERS相关的最常见的病原体之一，尽管据我们所知，欧洲以前只报告过一例。轮状病毒相关MERS后，无论治疗如何，大多数患者似乎都能完全康复。该病例与其他已发表的报告一起支持轮状病毒相关MERS不太可能是病毒直接侵入CNS的结果的假设。有人认为MERS可能是由髓鞘内轴突水肿或局部炎性细胞浸润引起的;然而，其发病机制仍不完全清楚。
Rotavirus is the most common cause of severe gastroenteritis in children under the age of 5 years worldwide. It is well recognised that rotavirus can cause signs and symptoms beyond the gastrointestinal tract, including neurological manifestations such as encephalopathy. Mild encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome that has been associated with rotavirus. We report a case of a 4-year-old boy with clinically mild encephalopathy, who had an isolated splenial lesion in the corpus callosum on neuroimaging, and rotavirus RNA detected in faeces. We use this case as an opportunity to review the literature on rotavirus-associated MERS. A previously healthy 4-year-old boy presented with a 2-day history of vomiting, diarrhoea, and fever, complicated by reduced level of consciousness. Magnetic resonance imaging of the brain showed a marked hyperintensity in the splenium of the corpus callosum on T2 and diffusion-weighted images. Rotavirus genome was detected by polymerase chain reaction in a stool specimen, but not in the cerebrospinal fluid. The genotype was identified as G1P8. His clinical condition improved with gradual resolution of his symptoms. No neurological complications were evident upon discharge and the patient had no recurring symptoms or significant residual defects when followed up 2 months later. MERS is a novel clinic-radiological syndrome first described in Japan. A transient splenial lesion with reduced diffusion that appears as a high signal intensity in diffusion-weighted MRI is the main diagnostic feature. Rotavirus is one of the most common agents associated with MERS, although to our knowledge only one previous case has been reported from Europe. The majority of patients appear to achieve full recovery following rotavirus-associated MERS, irrespective of treatment. This case, together with other published reports, supports the hypothesis that rotavirus-associated MERS is unlikely to be the result of direct viral invasion of the CNS. It has been suggested that MERS may be caused by intra-myelinic axonal oedema or local inflammatory cell infiltration; however, the pathogenesis remains incompletely understood.