MRI Findings in Children with Acute Flaccid Paralysis and Cranial Nerve Dysfunction Occurring during the 2014 Enterovirus D68 Outbreak
MRI Findings in Children with Acute Flaccid Paralysis and Cranial Nerve Dysfunction Occurring during the 2014 Enterovirus D68 Outbreak
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DOI：
10.3174/ajnr.a4188
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发表时间：
2015-02-01
影响因子：
3.5
通讯作者：
Stence, N. V.
中科院分区：
文献类型：
--
作者：
Maloney, J. A.;Mirsky, D. M.;Stence, N. V.
背景和目的：2014年8月和9月，肠道病毒D68在美国引起了广泛的呼吸道疾病暴发。在此期间，有几名患者因急性弛缓性麻痹和脑神经功能障碍来到我们的医院。本报告的目的是描述在肠道病毒D68爆发期间发生的这种神经系统综合征的独特影像学表现。材料和方法：符合急性弛缓性麻痹和/或颅神经功能障碍的特定病例定义并在研究期间到我们机构就诊的患者被纳入研究对象。所有患者均接受常规脑和/或脊髓磁共振成像，包括多平面T1、T2和对比增强T1加权成像。结果：11例患者符合纳入标准，并接受了脑和/或脊髓磁共振成像。9例患者表现为脑干病变，最常累及脑桥被盖，1例患者双侧面神经增强。10例患者有纵向广泛的脊髓病变；急性显像显示整个中央灰质受累，亚急性显像显示病变局限于前角细胞。4例患者马尾前神经根增强，3例患者颈前神经根增强，均仅在亚急性情况下发生。结论：在最近的肠病毒D68暴发期间，出现急性弛缓性麻痹和/或脑神经功能障碍的患者表现出独特的影像学表现，其特征是脑干和脊髓灰质病变，与之前病毒性脊髓炎（如肠病毒71和脊髓灰质炎）暴发中描述的神经影像学表现相似。
BACKGROUND AND PURPOSE: Enterovirus D68 was responsible for widespread outbreaks of respiratory illness throughout the United States in August and September 2014. During this time, several patients presented to our institution with acute flaccid paralysis and cranial nerve dysfunction. The purpose of this report is to describe the unique imaging findings of this neurologic syndrome occurring during an enterovirus D68 outbreak.MATERIALS AND METHODS: Patients meeting a specific case definition of acute flaccid paralysis and/or cranial nerve dysfunction and presenting to our institution during the study period were included. All patients underwent routine MR imaging of the brain and/or spinal cord, including multiplanar T1, T2, and contrast-enhanced T1-weighted imaging.RESULTS: Eleven patients met the inclusion criteria and underwent MR imaging of the brain and/or spinal cord. Nine patients presented with brain stem lesions, most commonly involving the pontine tegmentum, with bilateral facial nerve enhancement in 1 patient. Ten patients had longitudinally extensive spinal cord lesions; those imaged acutely demonstrated involvement of the entire central gray matter, and those imaged subacutely showed lesions restricted to the anterior horn cells. Ventral cauda equina nerve roots enhanced in 4 patients, and ventral cervical nerve roots enhanced in 3, both only in the subacute setting.CONCLUSIONS: Patients presenting with acute flaccid paralysis and/or cranial nerve dysfunction during the recent enterovirus D68 outbreak demonstrate unique imaging findings characterized by brain stem and gray matter spinal cord lesions, similar to the neuroimaging findings described in previous outbreaks of viral myelitis such as enterovirus 71 and poliomyelitis.