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目的:通过病例观察和文献复习探讨肠道病毒71型(EV71)感染合并急性弛缓性麻痹(AFP)的临床、影像学表现及特征。方法:报告2008-2010年中国海南EV71感染流行期间9例伴有AFP的EV71型感染手足口病患儿临床、MRI表现,并做文献复习,分析其可能机制。结果:9例患儿中,单侧肢体无力4例(其中单下肢3例,单上肢1例),双侧肢体无力3例(双下肢2例,双上肢1例),四肢无力2例,合并脑干脑炎3例。脊髓MRI示颈到圆锥髓内不同范围条形长T1长T2信号,病变集中于脊髓颈段及胸9-圆锥水平,横轴位显示脊髓双侧或单侧前角长T1长T2信号。3例合并脑干脑炎患者颅脑MRI示桥脑、延髓、中脑后部点状或模糊片状长T1、长T2信号,脊髓MRI增强扫描表现为受累脊髓前角轻度强化,同侧前根明显强化。结论:EV71型感染手足口病合并AFP损害部位常位于颈段及胸9-圆锥水平脊髓前角及前根。MRI是评价手足口病神经系统损害的有效方法,影像学表现具有相对特异性,对评估病情和判断预后有重要价值。
OBJECTIVE: To investigate the clinical and radiographic features and manifestations of enterovirus 71 (EV71) infection complicated with acute flaccid paralysis (AFP) through case observation and literature review. Methods: The clinical and MRI manifestations of 9 children with EV71 infection and HFMD accompanied by AFP during the epidemic of EV71 in Hainan during 2008-2010 were reported and reviewed. The possible mechanism was reported. Results: In 9 cases, unilateral limb weakness in 4 cases (including single lower limb in 3 cases, single upper limb in 1 case), bilateral limb weakness in 3 cases (double lower limb in 2 cases, double upper limb in 1 case), limb weakness in 2 cases, 3 cases of brain stem encephalitis. Spinal cord MRI showed a long, narrow and long T1 signal in different ranges from the neck to the conus medulla. The lesions were concentrated in the cervical segment of the spinal cord and the level of the chest 9-cone. The horizontal axis showed the long T1 long T2 signals of the bilateral or unilateral anterior horn of the spinal cord. 3 cases of brain encephalitis patients with cerebral plexus MRI showed pontine or medulla oblongata or fuzzy patchy long T1, long T2 signal, enhanced spinal cord MRI showed enhanced spinal cord anterior horn mild enhancement, ipsilateral Before the root significantly strengthened. Conclusion: The EV71-type HFMD complicated with AFP lesions are often located in the anterior horn and the anterior root of the spinal cord in the 9-conical and cervical segments. MRI is an effective method to evaluate the nervous system damage of hand, foot and mouth disease. The imaging manifestations are relatively specific and have important value in assessing the disease and prognosis.