Neurologic Manifestations of Enterovirus 71 Infection in Korea.
Neurologic Manifestations of Enterovirus 71 Infection in Korea.
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DOI：
10.3346/jkms.2016.31.4.561
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发表时间：
2016-04
影响因子：
4.5
通讯作者：
Kim DB
中科院分区：
文献类型：
--
作者：
Lee KY;Lee MS;Kim DB
肠病毒71型常累及中枢神经系统，并可出现多种神经系统表现。在这里，我们的目的是描述的临床特征，磁共振成像（MRI）的结果，并与肠道病毒71感染的神经系统并发症的患者的脑脊液（CSF）的配置文件。我们回顾性分析了2010年至2014年期间在蔚山大学医院住院的31例急性神经系统表现伴确诊肠道病毒71型感染的儿科患者的记录。患者的平均年龄为2.9 ± 5.5岁（范围：18天至12岁），80.6%的患者小于4岁。根据临床表现分为脑干脑炎21例，脑膜炎7例，脑炎2例，急性弛缓性麻痹1例。常见的神经系统症状包括肌阵挛（58.1%）、嗜睡（54.8%）、易激惹（54.8%）、呕吐（48.4%）、共济失调（38.7%）和震颤（35.5%）。25例患者进行了MRI扫描，其中14例（56.0%）显示脑干后部和双侧小脑齿状核T2信号强度增加。30例患者中有26例（86.7%）表现为CSF细胞增多。30例患者（96.8%）完全恢复，无任何神经功能缺损; 1例患者（3.2%）死于肺出血和休克。在本研究中，脑干脑炎是肠病毒71型感染最常见的神经系统表现。特征性临床症状如肌阵挛、共济失调和震颤伴脑脊液细胞增多和脑干病变是诊断肠道病毒71型感染累及神经系统的特异性表现。
Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients’ mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.