CAJ | 학술논문

目的提高儿科临床医师对急性出血性白质脑炎伴继发性癫痫的认识和诊治水平，减少儿童病死率，改善生活质量。方法1例幸存婴儿急性出血性白质脑炎伴继发性癫痫的发病经过、临床表现、实验室检查和影像学特点、诊治经过以及24个月随访，并进行相关文献复习。结果该患儿因高热、咳嗽、抽搐给予抗感染、对症等治疗，效果差，病情进展迅速，出现意识障碍、抽搐等，在积极对症治疗基础上，加用静脉用丙种球蛋白及甲基强的松龙冲击治疗后，安全渡过危险期，症状、体征改善。急性期后口服抗癫痫药物并每日正规康复训练，现遗留有运动和语言功能障碍，但神志清晰，反应可，能独坐，吞咽等均正常。结论急性出血性白质脑炎是一种感染后中枢神经系统炎性脱髓鞘病，病情凶险，常在数天内死亡，临床表现和影像学检查帮助早期、及时、正确诊断。在积极对症、支持治疗的基础上，迅速应用免疫抑制剂是挽救生命、减少病死率的关键。
목적제고인과림상의사대급성출혈성백질뇌염반계발성전간적인식화진치수평，감소인동병사솔，개선생활질량。방법1례행존영인급성출혈성백질뇌염반계발성전간적발병경과、림상표현、실험실검사화영상학특점、진치경과이급24개월수방，병진행상관문헌복습。결과해환인인고열、해수、추휵급여항감염、대증등치료，효과차，병정진전신속，출현의식장애、추휵등，재적겁대증치료기출상，가용정맥용병충구단백급갑기강적송룡충격치료후，안전도과위험기，증상、체정개선。급성기후구복항전간약물병매일정규강복훈련，현유류유운동화어언공능장애，단신지청석，반응가，능독좌，탄인등균정상。결론급성출혈성백질뇌염시일충감염후중추신경계통염성탈수초병，병정흉험，상재수천내사망，림상표현화영상학검사방조조기、급시、정학진단。재적겁대증、지지치료적기출상，신속응용면역억제제시만구생명、감소병사솔적관건。
ObjectiveThe purpose of this report was to present a surviving infant case diagnosed with acute hemorrhagic leukoencephalitis (AHLE) and thus help pediatrician to facilitate rapid recognition and treatment to AHLE.Method The pathogenic course, clinical manifestation, laboratory examination, and imaging features of one surviving case infant with AHLE associated with secondary epilepsy were evaluated and followed-up for 24 months. During this process, the related literatures were reviewed.Result CT scan, serial brain MRI and CSF were performed to confirm the diagnosis of AHLE. After anti-infection and symptomatic treatment of the infant with symptoms of high fever, cough, and convulsions, the infant got worse with the occurrence of continuous convulsions and alteration of consciousness. On the basis of symptomatic treatment, high-dose intravenous immunoglobulin, methylprednisolone and other treatments were further used to the infant, and the patient recovered greatly. By taking oral antiepileptic drugs and daily regular rehabilitation training after the acute time, the patient survived though several neurological sequelae remained.ConclusionThe key to save life lies in both early diagnose and comprehensive treatment. It is difficult to avoid the sequelae of nervous system.