A 6-year-old child with vacant episodes and unilateral convulsions
A 6-year-old child with vacant episodes and unilateral convulsions
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6岁小孩空位发作单侧抽搐
DOI：
10.1016/s0140-6736(98)09176-4
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
M. Pike
中科院分区：
文献类型：
--
作者：
D. Burgner;D. McDonald;Michael Watson;M. Pike
1998 年 5 月，一名原本健康的 6 岁女孩因出现空虚发作，随后出现持续 30 秒的右侧上肢和下肢阵挛性运动而入院。发热（38·6℃），神经系统检查正常，无脑膜炎。白细胞增多（22·7×10 9/L，中性粒细胞70%），尿路大肠杆菌感染。她接受了甲氧苄啶治疗，并于第二天出院回家，12 小时后因进一步痉挛而再次入院。她没有发烧，体检和白细胞计数正常。她有几次复杂的部分性癫痫发作。脑电图显示左额颞叶尖锐波。卡马西平停止了她的痉挛。她发病 10 天后，磁共振成像 (MRI) 扫描显示左额叶存在病因不明的病变（图 A）。她仍然没有发烧，身体健康，充满活力。白细胞计数为 12·10 9 L，ESR 30 mm/h，C 反应蛋白 20 mg/mL。脑脊液（CSF）未见细胞，蛋白（0·08 g/L）和葡萄糖（3·4 mmol/L；血清葡萄糖5·0 mmol/L）正常。开始静脉注射阿昔洛韦和头孢曲松。没有已知的结核病接触史，也没有免疫缺陷。开始使用阿昔洛韦和头孢曲松 48 小时后，她的病情恶化，出现呕吐和嗜睡。重复 MRI 扫描显示病变扩展并伴有水肿和中线移位（图 B）。脑脊液无菌，单纯疱疹病毒 (HSV)、水痘带状疱疹病毒和肠道病毒 PCR 呈阴性。添加甲硝唑。脑活检显示软脑膜和血管周围有弥漫性单核细胞浸润，并且细菌学无菌。
A previously well 6-year-old girl was admitted to hospital in May, 1998, after having a vacant episode followed by right-sided upper and lower limb clonic movements lasting 30 s. She was feverish (38· 6 C), neurological examination was normal, and she had no meningism. There was a leucocytosis (22· 7× 10 9/L, 70% neutrophils) and she had an Escherchia coli urinary-tract infection. She was given trimethoprim and discharged home the next day, to be readmitted 12 h later with further fits. She had no fever and physical examination and white-cell count were normal. She had several complex partial seizures. An electroencephalogram showed left frontotemporal sharp waves. Carbamazepine stopped her fits. 10 days after she became ill, a magnetic resonance imaging (MRI) scan showed a left frontal-lobe lesion of uncertain aetiology (figure A). She remained afebrile, well, and lively. Her white-cell count was 12· 10 9 L, ESR 30 mm/h, and C-reactive protein 20 mg/mL. Cerebrospinal fluid (CSF) showed no cells, and normal protein (0· 08 g/L) and glucose (3· 4 mmol/L; serum glucose 5· 0 mmol/L). Intravenous acyclovir and ceftriaxone were started. There was no known contact with tuberculosis and no immunodeficiency. 48 h after starting acyclovir and ceftriaxone she deteriorated, with vomiting and drowsiness. A repeat MRI scan showed extension of the lesion with oedema and midline shift (figure B). CSF was sterile and PCR for herpes simplex virus (HSV), varicella zoster virus, and enterovirus were negative. Metronidazole was added. A brain biopsy showed a diffuse mononuclear leptomeningeal and perivascular infiltrate and was bacteriologically sterile.
影响因子：
6.4
作者：
LAKEMAN, FD;WHITLEY, RJ;TILLES, J
通讯作者：
TILLES, J