儿童急性坏死性脑病--叙述性综述

Bidisha Banerjee, Ullas V. Acharya
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引用次数: 0

摘要

急性脑炎综合征(AES)在诊断和治疗方面具有挑战性。感染相关的急性脑病(ae)越来越多地被认识,并与ae非常相似。我们提供了AE的各种原因的概述和临床实验室的详细回顾,包括儿童急性坏死性脑病(ANE)的神经放射学特征,其治疗和结果。使用关键词“儿科急性脑病”和“儿童急性坏死性脑病”在PubMed和Google Scholar中进行文献检索,并回顾2001年至2021年的所有相关英文文章(包括病例报告)。并检讨2001年以前的相关及主要文章。感染相关的不良事件仍未得到充分认识,并对神经危重症护理构成挑战。明智地使用神经影像学和实验室检查有助于诊断特定的临床放射AE综合征。如果发烧(特别是病毒性疾病)之后伴有与音调异常或癫痫发作相关的感觉迅速恶化,我们需要怀疑ANE。神经影像学通常显示丘脑、内囊或小脑白质和被盖的对称病变。虽然没有明确的治疗指南,但一些干预措施已经显示出支持ANE患者的潜在益处。这些措施包括标准的支持治疗,免疫治疗,特别是高剂量的甲基强的松龙,在12小时前开始治疗性低温以减少细胞因子,以及抗水肿措施。然而,必须注意的是,ANE的结果可能是高度可变的,死亡率约为30%,只有10%的患者能够完整生存。不良预后的预测因素包括年龄小于1岁,脑脊液蛋白/转氨酶升高,神经影像学上存在出血/空化/脑干病变,以及ANE严重程度评分较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute necrotising encephalopathy of childhood – A narrative review
Acute encephalitis syndrome (AES) can pose challenges in diagnosis and management. Infection-associated acute encephalopathies (AEs) are increasingly being recognised and closely mimic AES. We provide an overview of various causes of AE and a detailed review of the clinical laboratory, including neuroradiologic features of acute necrotising encephalopathy (ANE) of childhood, its treatment, and outcome. A literature search was performed using the keywords’ Paediatric acute encephalopathy’ and ‘acute necrotising encephalopathy of childhood’ in PubMed and Google Scholar, and all relevant articles from 2001 to 2021 (including case reports) in the English language were reviewed. Relevant and major articles before 2001 were also reviewed. Infection-associated AEs remain under-recognised and pose a challenge in neurocritical care. Judicious use of neuroimaging and laboratory tests aids diagnosis of specific clinicoradiological AE syndromes. We need to suspect ANE if fever (esp. viral illness) is followed by the rapid deterioration in the sensorium associated with tone abnormalities or seizures. Neuroimaging typically shows symmetric lesions in the thalami, internal capsule or cerebellar white matter and tegmentum. While definite treatment guidelines are not available, several interventions have shown potential benefits in supporting patients with ANE. These include standard supportive care, immunotherapy, especially high-dose pulse methylprednisolone, therapeutic hypothermia initiated before 12 h to reduce cytokines, and anti-oedema measures. However, it is essential to note that outcomes in ANE can be highly variable, with a mortality rate of approximately 30% and only 10% experiencing intact survival. Predictors of poor outcome include age younger than one year, increased cerebrospinal fluid protein/transaminases, the presence of haemorrhage/cavitation/brainstem lesions on neuroimaging, and a high ANE severity score.
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