论文部分内容阅读
目的:分析以脓毒症样表现起病的感染后播散性脑脊髓炎的临床特征,提高对此类疾病的认识。方法 :总结6例以脓毒症样表现起病的感染后播散性脑脊髓炎的临床资料、实验室检查、影像学资料及随访结果。结果:6例患儿以头痛伴反复发热为主诉就诊,病程中有嗜睡或抽搐;应用过头孢菌素,甚至碳青霉烯类抗菌药物,由于脑脊液持续呈混合细胞反应,甚至曾应用抗结核药物;外周血白细胞(17.8~25.9)×109个/L,中性粒细胞78.3%~90.0%;脑脊液白细胞(100~>500)×106个/L,中性粒细胞40%~79%;血降钙素原(PCT)正常或0.25~0.50 ng/m L,病初头颅CT或MRI正常,入院后10~30 d复查头颅MRI提示皮层下白质和(或)深部白质脱髓鞘改变,部分累及基底节区;经单用糖皮质激素或联合丙种球蛋白治疗,均好转,临床症状消失,外周血象和脑脊液逐渐恢复正常,复查头颅MRI病灶消失或大部分吸收。结论:部分感染后脑脊髓炎,病初伴有脓毒症样表现,反复发热,外周血白细胞明显升高,中性粒细胞比例高,脑脊液呈混合细胞反应持续时间长,PCT基本正常,血及脑脊液培养阴性,抗菌药物治疗无效,早期头颅影像学正常,病程中需注意及时复查影像学,早期发现,早期治疗,提高治疗效果,减少抗菌药物应用。
OBJECTIVE: To analyze the clinical features of disseminated encephalomyelitis following infection with sepsis-like symptoms and to raise awareness of such diseases. Methods: Six cases of disseminated encephalomyelitis with sepsis-like onset were retrospectively analyzed. The clinical data, laboratory examination, imaging data and follow-up results were summarized. Results: 6 cases of children with headache with recurrent fever as the main complaint, drowsiness or convulsions in the course of the course; the application of cephalosporins, and even carbapenem antibiotics, as the cerebrospinal fluid continued mixed cell response, and even had anti-TB The number of leukocytes in peripheral blood (17.8 ~ 25.9) × 109 / L, neutrophils in 78.3% ~ 90.0%, cerebrospinal fluid leukocytes (100 ~ 500) × 106 / L and neutrophils in 40% ~ 79% Normal blood plasma procalcitonin (PCT) or 0.25 ~ 0.50 ng / m L, the initial head CT or MRI normal, 10 to 30 days after admission review of the skull MRI showed cortical white matter and (or) deep white matter demyelination changes, Partially involving the basal ganglia; single glucocorticoid or gamma globulin treatment, were improved, clinical symptoms disappeared, peripheral blood and cerebrospinal fluid gradually returned to normal, review of the skull MRI lesions disappear or most of the absorption. Conclusion: Encephalomyelitis after partial infection was associated with sepsis-like symptoms at the beginning of the illness. Repeated fever, peripheral blood leukocytes were significantly increased, the proportion of neutrophils was high. The mixture of cerebrospinal fluid was mixed for a long time, PCT was normal, Cerebrospinal fluid culture negative, antimicrobial therapy ineffective, early normal craniogram, the course of the disease should pay attention to timely review imaging, early detection and early treatment, improve the therapeutic effect and reduce the application of antimicrobial agents.