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目的 探讨肠道病毒71(EV71)相关手足口病(HFMD)合并中枢神经系统损伤的临床及MRI特征.方法 回顾性分析2008年8月至2010年11月温州医学院附属第二医院的35例伴有神经系统损伤的EV71感染HFMD患儿临床、发病初及随访时MRI资料,并总结其临床、MRI及随访特点.结果 35例中,6例合并无菌性脑膜炎,临床存在脑膜炎症状及体征,5例MRI表现为硬膜下腔增宽和(或)脑室扩大,随访时无神经系统后遗症.24例合并脑干脑炎,其中I级12例表现为肌阵挛合并震颤和(或)共济失调,Ⅱ级4例表现为肌阵挛及颅神经受累,Ⅲ级8例表现为中枢受累后心肺衰竭.其MRI主要表现为脑干背侧异常长T1长T2信号,可伴有小脑齿状核、尾状核及豆状核受累.随访时,临床表现较轻者无神经系统后遗症,脑干病灶多吸收消失,重者残留神经系统后遗症,脑干病灶多吸收变小、软化.9例合并急性弛缓性瘫痪,相应肢体肌力下降、肌张力减弱、腱反射减弱或消失.MRI表现为脊髓前角区长T1长T2信号灶.随访时受累肢体肌力得到不同程度的恢复,脊髓病灶多吸收好转.结论 MRI是评价EV71感染HFMD神经系统损害及观察预后的有效影像手段,影像表现具有相对特异性,损害部位常位于脑干背侧、脊髓前角.经积极治疗后,随访时患儿多无神经系统后遗症,其神经系统病灶多明显吸收.

Objective To explore the clinical and magnetic resonance imaging(MRI)characteristics and the follow-up outcomes of neurologic complications in children with enterovirus 71-infected hand-foot-mouth disease.Methods The clinical and MRI manifestations and follow-up outcomes in 35 children,at Second Affiliated Hospital,Wenzhou Medical College from August 2008 to November 2010,hospitalized with neurologic complications of enterovirus 71-infected hand-foot-mouth disease were retrospectively analyzed.Results Six children with aseptic meningitis presented the clinical symptoms and signs of meningitis.Five of them showed subdural effusion and ventriculomegaly,or both on MRI.At followups,neurologic sequel could not be found.Among 24 cases with brainstem encephalitis,there were myoclonic jerks and tremor,ataxia,or both(grade Ⅰ disease,n =12),myocloous and cranial-nerve involvement(grade Ⅱ disease,n =4),and cardiopulmonary failure after brain-stem infection(grade Ⅲdisease,n =8).In patients with brainstem encephalitis,lesions were predominantly located at the posterior portions of medulla and pons with hypointensity on T1WI and hyperintensity on T2WI.Cerebellar dentate nucleus,caudate nucleus and lenticular nucleus could also be involved.At follow-ups,the patients with mild symptoms had no neurologic sequel and the lesions within brain stem became small or vanished in most cases.While in the majority of serious patients,neurologic sequel could be found and the lesions located at brain stem became encephalomalacia.Fourteen cases with acute flaccid paralysis presented acute limb myasthenia with tendon reflex and muscular tension decreased.On spinal MRI,the lesions predominantly involved anterior horn regions of spinal cord with hypointensity on T1WI and hyperintensity on T2WI.Most patients improved their muscle strength and most lesions of spinal cord became smaller or vanished during follow-ups.Couclusion MRI is the most effective modality of diagnosis and follow-up for neurologic complications in children with enterovirus 71-infected hand-foot-mouth disease.On MRI,the lesions mainly involve the anterior horn of spinal cord,medulla oblongata and pons.At follow-ups,most patients have no neurologic sequel and the visualized lesions will be absorbed after active treatment.