目的：分析儿童抗N-甲基-D-天冬氨酸（N-methyl-D-aspartate，NMDA）受体脑炎头颅MRI表现与临床特征。方法：对34例抗NMDA受体脑炎患儿进行影像资料与临床资料综合分析，并在入院时、入院治疗6月后全部进行改良的疾病严重程度评分（mRS）。结果：34例患儿中17例MRI表现异常，MRI表现异常者T2WI、FLAIR序列呈高信号。异常信号灶多分布于颞叶、岛叶、额顶枕叶，部分病灶亦可见于基底节、丘脑、胼胝体及脑干、小脑，其中6例伴有脑膜和/或脑实质病灶明显强化。首发症状癫痫位于第一位（74%），其次精神行为异常（35%）、发热（32%）、运动障碍（17.6%）、意识障碍（17.6%）。癫痫发作、精神行为异常、发热、运动障碍、意识障碍、单纯疱疹病毒感染患儿MRI表现正常者与MRI表现异常者差异无统计学意义（P＞0.05），34例患儿中MRI表现正常与MRI表现异常的年龄分布差异无统计学意义（P＞0.05）。入院mRS评分，MRI表现正常者与MRI表现异常者差异无统计学意义（P＞0.05），治疗6月后mRS评分，MRI表现正常者平均评分低于MRI表现异常者，差异有统计学意义（P＜0.05）。结论：儿童抗NMDA抗体受体脑炎MRI表现正常者预后较好、治愈率高，MRI异常者常提示预后较差。
Abstract
Objective: To discuss the imaging and clinical features of anti-N-methyl-D-aspartate(NMDA) receptor encephalitis patients in children. Methods: Thirty-four anti-NMDA receptor encephalitis patients in children were included. We analyzed the brain MRI findings and the clinical characteristics. The modified Rankin scale(mRS) was applied on admission and after 6 months for each patient. Result: The brain MRI was abnormal in 17/34 patients. The initial MRI was abnormal on T2 or fluid-attenuated inversion recovery(FLAIR) as hyper-intensity signals. They were seen in the temporal lobe, insular lobe, frontal and parietal and occipital lobe. Some of them were also found in basal ganglia, thalamus, corpus callosum, brainstemand cerebellum. Six has leptomeningeal enhancement and/or abnormal enhancement of parenchyma. The first symptom is seizure, followed by mental and behavioral disorders(35%), fever(32%), motor disorders(17.6%) and loss of consciousness(17.6%). There were no statistically significant differences between the MRI findings and clinical presentations(seizure, mental and behavioral disorders, fever, motor disorders, oss of consciousness, erpes simplex virus infection)(P>0.05). There was no statistically significant difference in MRI findings(normal or abnormal) between 34 patients with different age(P>0.05). There was no statistically significant difference in MRI findings(normal or abnormal) between the mean mRS score at 0-month follow-up(P>0.05). The mean mRS score at the 6-month follow-up was significantly lower in patients with normal MRI than in patients with abnormal MRI(P<0.05). Conclusion: The patients with normal MRI had improved outcomes, and the patients with abnormal MRI had poor outcoms.
关键词
脑炎；儿童；受体 /
N-甲基-D-天冬氨酸；磁共振成像
Key words
Encephalitis /
Child /
Receptors, N-methyl-D-aspartate /
Magnetic resonance imaging
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