Serial MRI findings of acute flaccid myelitis during an outbreak of enterovirus D68 infection in Japan
Serial MRI findings of acute flaccid myelitis during an outbreak of enterovirus D68 infection in Japan
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DOI：
10.1016/j.braindev.2018.12.001
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发表时间：
2019-05-01
影响因子：
1.7
通讯作者：
Tanaka-Taya, Keiko
中科院分区：
文献类型：
--
作者：
Okumura, Akihisa;Mori, Harushi;Tanaka-Taya, Keiko
目的：阐明EV-D68感染暴发期间急性弛缓性脊髓炎患儿的神经影像学表现。方法：我们对54例急性弛缓性脊髓炎患儿的脊柱和颅脑MRI结果进行了详细的回顾。我们专注于纵向病变的范围、水平切片内病变的定位和外观、钆增强以及随时间的变化。结果：所有儿童均有累及中央灰质的纵向脊髓病变。26名儿童的病灶横跨整个脊柱。其中6人四肢无力，而7人只有一个肢体无力。38名儿童的灰质和白质都有病变，这些儿童的肢体无力往往更严重。在急性期，脊髓病变表现为双侧范围不清的广泛性T2高信号。在亚急性期，病变明确，局限于前角。肢体无力的分布与亚急性期病变的出现相关。37例患儿行钆增强，29例患儿马尾增强。在发病后2天内增强并不常见，但此后几乎所有儿童均可见。22例患儿脑干病变伴脊柱病变。结论：儿童急性弛缓性脊髓炎具有广泛的纵向脊髓损伤的特点。在急性期，病变通常是双侧和广泛的，而定位到前角可能变得明显。虽然经常观察到马尾增强，但其出现有时延迟。(C) 2018日本儿童神经病学学会。Elsevier B.V.版权所有。
Objecive: To clarify the neuroimaging findings of children with acute flaccid myelitis during an outbreak of EV-D68 infection.Methods: We performed a detailed review of the spinal and cranial MRI results of 54 children with acute flaccid myelitis. We focused on the range of longitudinal lesions, the localization and appearance of lesions within a horizontal section, Gadolinium enhancement, and changes over time.Results: All children had longitudinal spinal lesions involving central gray matter. Twenty-six children had lesions spanning the entire spine. Six of them had weakness in all limbs, whereas seven had weakness of only one limb. Thirty-eight children had lesions in both gray and white matter and limb weakness tended to be more severe in these children. During the acute period, spinal lesions showed bilateral ill-defined widespread T2 hyperintensity. During the subacute period, lesions were well defined and confined to the anterior horn. The distribution of limb weakness was correlated with the appearance of lesions during the subacute period. Gadolinium enhancement was performed in 37 children, and enhancement was seen in the cauda equina in 29 children. Enhancement was infrequent within 2 days after onset but was seen in almost all children thereafter. Twenty-two children had brainstem lesions continuous with spinal lesions.Conclusion: Extensive longitudinal spinal lesions were characteristic in children with acute flaccid myelitis. Lesions were usually bilateral and widespread during the acute period, whereas localization to the anterior horn could become obvious. Although enhancement of the cauda equina was often observed, its appearance was sometimes delayed. (C) 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.