MR Imaging Findings of Epidemic Enterovirus 71 Encephalitis in Infants and Young Children

幼兒流行性腸病毒第71型腦炎之磁振造影表現

陳震宇(Chen-Yu Chen) ； 張英昭(Ying-Chao Chang) ； 黃朝慶(Chao-Ching Huang) ； 呂鎮中(Chun-Chung Lui) ； 俞芹英(Chin-Yin Yu) ； 王志堅(Ji-Gen Wan) ； 喻永生(Yeong-Seng Yuh)

《中華放射線醫學雜誌》 25卷2期 (2000/04) Pp. 45-52

摘要

我們於民國八十七年四月至十二月台灣腸病毒第71型感染流行期間，收集了44例經病毒培養證實有腸病毒第71型感染合併腦炎的嬰幼兒，其中有27例接受腦部磁振造影檢查。
二十七例病童總共接受三十二次磁振造影檢查（包含五次追蹤檢查），其中有二十例在T2權重影像發現有不正常高訊號在腦幹蓋部，另外七例磁振造影結果為正常。典型的腸病毒腦炎臨床表徵為跳躍式上肢抽動，震顫，走路不穩，和顱神經麻痺，七位嚴重病患合併停止呼吸和急性心肺衰竭。二十五例在急性期接受磁振造影檢查的病童中，有十八例發現在腦幹和上頸脊髓有T2高訊號病灶，病灶發現頻率依序分別為：橋腦（18/25, 72%）、延腦（15/25，60%），中腦（包括腦蓋，黑質區和上小腦腳）（11/25, 44%）。另外部份在小腦齒狀核區（8/25, 32%）和上頸脊髓（6/25, 24%）也發現有高訊號病灶。二十五例中有五例接受追蹤磁振造影檢查，其中四例腦幹病灶消失（臨床也無症狀），另一例有持續性的說話不清和腦幹病灶。二例在急性期使用呼吸機治療的病人於慢性期接受磁振造影檢查，影像發現腦幹蓋部從中腦到延腦均呈現壞死。
幼兒流行性腸病第71型腦幹腦炎之磁振造影有典型表徵，大多數病灶發現在腦幹蓋部，影像發現與臨床症狀相符，多數腦炎病患會自然痊癒，嚴重病患多因腦幹蓋部不可逆壞死。磁振造影可在腦幹腦炎急性期證實腦幹病灶，並提醒臨床醫師有所準備，預防嚴重病患有心肺衰竭的可能。

關鍵字

腸病毒第71型感染 ； 腦幹腦炎 ； 磁振造影

並列摘要

To investigate the magnetic resonance imaging (MRI) findings of acute neurological complications in infants and young children with enterovirus 71 (VE71) infections.
MRI studies were obtained for 27 or 44 infants and young children who had acute encephalitic symptoms and positive VE71 isolations during an outbreak of hand, foot, and mouth disease in Taiwan from April through December 1998.
Among the 27 patients with a total of 32 MRI studies (including five follow-up scans), 20 had abnormal T2 high-signal lesions in the brain stem and the other 7 were normal. The characteristic features of brain stem encephalitis encompassed myoclonic jerks, tremors, ataxia, cranial nerve palsy and, in seven severe cases, apnea and acute neurogenic cardiopulmonary collapse. Among 25 patients who had MRI during the acute stage of illness, 18 showed high signal T2-swighted lesions in the brain stem and/or upper cervical cord. The brain stem lesions observed of MRI were most commonly at the tegmentum of the pons (18/25, 72%) followed by the medulla oblongata (15/25, 60%) and the midbrain which includes the tegmentum, substantia nigra and superior cerebellar peduncles (11/25, 44%). Abnormal signal intensities were also seen in dentate nuclei (8/25, 32%) and upper cervical cord (6/25, 24%). Follow-up MRI in five patients showed normal findings in four patients who had complete recovery, and brain stem atrophy and T2 high-signal abnormalities in the other who had residual deficits. MRI findings during the chronic stage from two patients with prolonged ventilation who had survived from acute cardiopulmonary collapse showed necrosis of the midbrain, the tegmentum of the pons and the medulla oblongata.
The MRI findings of EV71 brain stem encephalitis are unique. Young children with epidemic hand, foot, and mouth disease complicated with myoclonus, tremor, ataxia, oculomotor palsy or acute cardiopulmonary collapse should raise the suspicion of EV71 infection. MRI is particularly useful in the early detection of the brain stem lesions that may suggest the diagnosis of EV71 infection before the virus can be isolated.

並列關鍵字

Enterovirus 71 infection ； Brain stem encephalitis ； Magnetic resonance imaging