- 期刊
Epstein-Barr Virus Encephalitis in Children
兒童之EB病毒腦炎
摘要
本篇收集1988年到1998年，十年間住院於兒科病房之Epstein-Barr(EB)病毒腦炎病例十四名，共七名男性、七名女性，發病年齡從10個月至14歲不等。其中，五例屬於急性病毒性腦炎，一例為急性EB病毒腦膜腦炎後拼發小腦炎，另有三例屬於急性彌漫性腦脊髓炎。其臨床症狀以抽搐(36%)、發燒(43%)、怪異行為(31%)及視覺變形『metamrphopsia』(36%)為主；而理學表徽則出現多樣神經學表現，包括不同程度之意識不清，腦膜刺激現象、錐體病徽、腦幹病徽、小腦病徽及皮顱神經麻等。實驗室檢顯示只有一例有不典型淋巴球，但全部病例皆出現EB病毒之陽性血清反應。神經生理影像檢查中，十二例病人的腦波檢查有八例不正常，但大都為非物異性慢波；電腦斷層掃描檢查，在五例病人中有四例出現腦水腫現象，而核磁共振掃描則九例中有五例顯出不同部位這異常影像；有四例病人接受單光子射出斷層掃描結果三例出現不正常低吸收病灶。本研究證實EB病毒腦炎神經學之多樣性，且皆末出現典型EB病毒腦炎神經學之多樣性，且皆末出現典型EB病毒感染或傳染性單核球症之臨床症狀及理學表征，因此任何原因不明之小兒神經病症均應攷慮EB病毒感染之可能性。
並列摘要
Fourteen children with Epstein-Barr virus (EBV) encephalitis admitted to our pediatric department during the period 1988 to 1998 were collected and reviewed to characterize the clinical, laboratory and neuroradiological findings. There were 7 boys and 7 girls. The age of onset ranged from 10 months to 14 years. Among them, 5 patients belonged to Alice in Wonderland syndrome, 5 were diagnosed as acute viral encephalitis, I presented with acute meningoencephalitis followed by cerebellitis, the remaining 3 cases attributed to acute disseminated encephalomyelitis. The main symptoms were fever (43%), seizure (36%), bizarre behavior (31%), headache (21%) and metamorphopsia (36%). The presenting signs included altered consciousness (50%), meningeal sign (14%), bid bar sign (14%), cerebellar sign (7%), and cranial nerve palsy (7%). Classic findings of infectious mononucleosis were obscure. The laboratory data showed the existence of atypical lymphocyte in only one case but positive serology for EBV infection in all patients. Pleocytosis was found in 3 (30%) of 10 patients examined. Eight (67%) of 12 patients had nonspecific electroencephalographic changes in the acute stage. Computed tomography (CT) scans were abnormal in 2 (40%) of 5 patients tested, while magnetic resonance image (MRI) disclosed lesions in 5 (56%) of 9 patients, with abnormal signals in various parts of the brain. Single photon emission computed tomography (SPECT) brain scan showed abnormal perfusion lesions in 3 (75%) of 4 patients studied. The results demonstrate the diversity of neurological manifestations of EBV encephalitis. EBV should be considered in any acute neurological illness of uncertain etiology in the pediatric population. While MRI remains the image of choice in EBV encephalitis, SPECT detects the abnormal perfusion more precisely in a substantial number of patients.