Two newly proposed infectious encephalitis/encephalopathy syndromes
Two newly proposed infectious encephalitis/encephalopathy syndromes
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DOI：
10.1016/j.braindev.2009.02.012
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发表时间：
2009-08-01
影响因子：
1.7
通讯作者：
Takanashi, Jun-ichi
中科院分区：
文献类型：
--
作者：
Takanashi, Jun-ichi
已经对两种新提出的传染性脑炎/脑病综合征进行了综述，其中磁共振成像（MRI）对于诊断至关重要。仅在东亚婴儿中报道了伴有双相癫痫发作和晚期扩散减少的急性脑病（AESD），其特征是第 1 天以热性惊厥（通常> 30 分钟）为初始神经系统症状，随后在第 4 至 6 天出现继发性癫痫发作；受影响的儿童表现出不同程度的神经系统后遗症。头两天MRI未显示急性异常；第 3 至 9 天期间，额叶或额顶叶皮层下白质中出现弥散减少，然后在第 9 天至 25 天之间消失。根据 MR 波谱结果，推测兴奋性毒性损伤伴迟发性神经元死亡是一种可能的机制。具有可逆性压部病变 (MERS) 的临床轻度脑炎/脑病的特点是可逆性病变 胼胝体弥散均匀减少（至少累及压部），有时与对称白质病变相关。最常见的神经系统症状是精神错乱，其次是意识障碍和癫痫发作，所有这些症状都会在一个月内完全恢复。病灶内扩散暂时减少的原因尚不清楚；假设的可能性包括髓鞘内水肿、紧密排列的纤维间质水肿和短暂的炎症浸润。 (C) 2009 Elsevier B.V. 保留所有权利。
Two newly proposed infectious encephalitis/encephalopathy syndromes, in which magnetic resonance imaging (MRI) is essential for the diagnosis, have been reviewed. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is reported only in East Asian infants, characterized by a febrile seizure (usually >30 min) as the initial neurological symptom on day 1, followed by secondary seizures at day 4 to 6; affected children display variable levels of neurological sequelae. MRI shows no acute abnormality during the first two days; reduced diffusion appears in the frontal or fronto-parietal subcortical white matter during days 3 to 9, then disappears between days 9 and 25. Excitotoxic injury with delayed neuronal death is hypothesized as a possible mechanism based on MR spectroscopic findings.Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is characterized by a reversible lesion with homogenously reduced diffusion in the corpus callosum (at least involving the splenium), sometimes associated with symmetrical white matter lesions. The most common neurological symptom is delirious behavior, followed by consciousness disturbance, and seizures, all of which completely recover within a month. The reason for the transiently reduced diffusion within the lesions is unknown; possibilities that have been postulated include intramyelinic edema, interstitial edema in tightly packed fibers, and a transient inflammatory infiltrate. (C) 2009 Elsevier B.V. All rights reserved.