急性脑炎的MRI研究进展

摘要/Abstract

摘要： 急性脑炎是由病毒、细菌、真菌或其他微生物引起的以中枢神经系统损害为主的传染病, 该病可危及生命, 若早期采取积极有效的治疗措施, 可提高治愈率。临床上对于典型急性脑炎患者, 可结合神经系统症状和感染体征进行诊断, 而疑似患者往往诊断较难。影像学检查对于各类病原体引起的急性脑炎的诊断至关重要, 尤其是在行腰椎穿刺后, 立即进行颅脑MRI检查是诊断急性脑炎的首选方式。颅脑MRI检查可提示诊断, 有时甚至可提示病原体;它不仅能评估脑损伤的程度, 还能排除一些主要的鉴别诊断, 如脑血管性病变或肿瘤。目前国内对各类病原体引起脑炎的MRI表现的综述较少, 本文简要综述了部分病毒及细菌性脑炎的发病机制和不同病原体引起的脑炎的MRI表现, 以利于早期准确诊断, 指导临床进行及时有效的治疗。

关键词: 急性脑炎, 病原体, MRI

Abstract: Acute encephalitis is an infectious disease caused by viruses, bacteria, fungi or other microorganisms, which will mainly cause by central nervous system damage. This disease can be life-threatening. If active and effective treatment measures can be taken earlier, the cure rate will be improved. In clinical practice, patients with typical acute encephalitis can be diagnosed by neurological symptoms and signs of infection, while suspected patients are often difficult to be diagnosed. Imaging examination is crucial for the diagnosis of acute encephalitisby various pathogens, especially after the lumbar puncture. Immediate MRI examination of the brain is the first choice for the diagnosis of acute encephalitis ^[1]. Brain MRI can prompt diagnosis and sometimes even can discover pathogens. It can not only assess the extent of brain damage, but also exclude some major differential diagnoses, such as cerebrovascular lesions or tumors^[2]. At present, there are few reviews about MRI manifestations of encephalitis caused by various pathogens in China. This article briefly reviews the pathogenesis of some viruses and bacterial encephalitis and the MRI manifestations of encephalitis caused by different pathogens, in order to facilitate early accurate diagnosis and guide clinical practice timely and effectively.

Key words: Acute encephalitis, Pathogen, MRI

龚晓明, 鲁植艳. 急性脑炎的MRI研究进展[J]. 新发传染病电子杂志, 2019, 4(4): 240-243.

GONG Xiao-ming, LU Zhi-yan. Research progress of acute encephalitis in MRI[J]. Electronic Journal of Emerging Infectious Diseases, 2019, 4(4): 240-243.

参考文献

[1] Steiner I, Budka H, Chaudhuri A, et al.Viral meningo-encephalitis: a review of diagnostic methods and guidelines for management: viral meningoencephalitis[J]. Eur J Neurol, 2010, 17(8): 999-1057.
[2] Sili U, Kaya A, Mert A, et al.Herpes simplexvirus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients[J]. J Clin Virol, 2014, 60(2):112-118.
[3] Raschilas F, Wolff M, Delatour F, et al.Outcome of and prognostic factors for herpes simplexencephalitis in adult patients: results of a multicenter study[J]. Clin Infect Dis, 2002, 35(3):254-260.
[4] Dagsdóttir HM, Sigurðardóttir B, Gottfreðsson M, et al.Herpes simplex encephalitis in Iceland 1987-2011[J].Springer Plus, 2014, 3:524.
[5] Sheybani F, Arabikhan HR, Naderi HR.Herpes simplex encephalitis (HSE) and its outcome in the patients who were admitted to a tertiarycare hospital in Mashhad, Iran over a 10-year period[J]. J Clin Diagn Res, 2013, 7(8):1626-1628.
[6] Mondal G, Kumar R, Ghosh JK, et al.Basal ganglia involvement in a child with herpes simplex encephalitis[J]. Indian J Pediatr 2009, 76(7):749-750.
[7] Navin P, Delanty N, Brennan P, et al. Herpes simplex virus encephalitis involving the right thalamus[J]. Case Reports, 2013, 2013(jun19 1): bcr2013010206-bcr2013010206.
[8] Huang YC, Weng HH, Tsai YT, et al.Periictal magnetic resonance imaging in status epilepticus[J]. Epilepsy Res, 2009, 86(1):72-81.
[9] Lo WB, Wilcock DJ, Carey M, et al.Herpes encephalitis complicated by cerebral haemorrhage[J]. J Neurol Neurosurg Psychiatry, 2013, 84(12):1404-1406.
[10] Küker W, Nägele T, Schmidt F, et al.Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases[J]. Neuroradiology, 2004, 46(2):122-125.
[11] Sawlani V.Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis[J]. J Neurol Sci, 2009, 287(1-2):221-226.
[12] Duckworth JL, Hawley JS, Riedy G, et al.Magnetic resonance restricted diffusion resolution correlates with clinical improvement and response to treatment in herpes simplex encephalitis[J]. Neurocrit Care, 2005, 3(3): 251-253.
[13] Nagel MA, Cohrs RJ, Mahalingam R, et al.The varicella-zoster virus vasculopathies: clinical CSF, imaging and virologic features[J]. Neurology, 2009, 72(11):1028-1030.
[14] Cheng-Ching E, Jones S, Hui FK, et al.High-resolution MRI vessel wall imaging in varicella-zoster virus vasculopathy[J]. J Neurol Sci, 2015, 351(1-2):168-173.
[15] Chiang F, Panyaping T, Tedesqui G, et al.Varicella-zoster cns vascular complications: a report offour cases and literature review[J]. J Neuroradiol, 2014, 27(3):327-333.
[16] Matsuo K, Uozumi Y, Miyamoto H, et al.Varicella-zoster vasculitis presenting with cerebellar hemorrhage[J]. J Stroke Cerebrovasc Dis, 2015, 24(6):e153-155.
[17] González-Suárez I, Fuentes-Gimeno B, Ruiz-Ares G, et al.Varicella-zoster virus vasculopathy. A review description of a new case with multifocal brain hemorrhage[J]. J Neurol Sci, 2014, 338(1-2):34-38.
[18] Broucker T, Mailles A, Chabrier S, et al.Acute varicella zoster encephalitis without evidenceof primary vasculopathy in a case-series of 20 patients[J]. Clin Microbiol Infect, 2012, 18(8):808-819.
[19] Ragin AB, Wu Y, Gao Y, et al.Brain alterations within the first 100 days of HIV infection[J]. Ann Clin Transl Neurol, 2015, 2(1):12-21.
[20] Yamamoto W, Ogusa E, Matsumoto K, et al.Human herpesvirus-6 encephalopathy after hematopoietic stem cell transplantation and class I human leukocyte antigen[J]. Clin Transplant, 2014, 28(5):540-545.
[21] Bhanushali MJ, Kranick SM, Freeman AF, et al.Human herpes 6 virus encephalitiscomplicating allogeneic hematopoietic stem cell transplantation[J]. Neurology, 2013, 80(16):1494-1500.
[22] Berger JR.The clinical features of PML[J]. Cleve Clin J Med, 2011, 78:S8-12.
[23] Sahraian MA, Radue E-W, Eshaghi A, et al.Progressive multifocal leukoencephalopathy: a review of the neuroimaging features and differential diagnosis[J]. Eur J Neurol, 2012, 19(8):1060-1069.
[24] Sahraian MA, Radue E-W, Eshaghi A, et al.Progressive multifocal leukoencephalopathy: a review of the neuroimaging features and differential diagnosis: progressive multifocal leukoencepha[J]. Eur J Neurol, 2012, 19(8):1060-1069.
[25] Friedman DP, Flanders AE.MR imaging of BK virus encephalitis[J]. Am J Neuroradiol, 2006, 27(5):1016-1018.
[26] Patkar D, Narang J, Yanamandala R, et al.Central nervous system tuberculosis: pathophysiology and imaging findings[J]. Neuro Clin N Am, 2012, 22(4):677-705.
[27] Singh P, Paliwal VK, Neyaz Z, et al.Clinical and magnetic resonance imaging characteristics oftubercular ventriculitis: an under-recognized complication of tubercularmeningitis[J]. J Neurol Sci, 2014, 342(1-2): 137-140.
[28] Singh B, Garg RK, Singh MK, et al.Computed tomography angiography in patients with tuberculous meningitis[J]. J Infect, 2012, 64(6):565-572.
[29] Kalita J, Prasad S, Maurya PK, et al.MR angiography in tuberculous meningitis[J]. Acta Radiol, 2012, 53(3):324-329.
[30] Honnorat E, De Broucker T, Mailles A, et al.Encephalitis due to Mycobacterium tuberculosis in France[J]. Med Mal Infect, 2013, 43(6):230-238.
[31] Arslan F, Meynet E, Sunbul M, et al.The clinical features, diagnosis, treatment, and prognosisof neuroinvasive listeriosis: a multinational study[J]. Eur J Clin Microbiol Infect Dis, 2015, 34(6):1213-1221.
[32] DeJesus-Alvelo I, Merenda A. A case report of Listeria monocytogenes abscesses presenting as cortically predominant ring-enhancing lesions[J]. Case Rep Neurol, 2015, 7(1):105-109.
[33] Xiang T, Li G, Xiao L, et al.Neuroimaging of six neurosyphilis cases mimicking viralencephalitis[J]. J Neurol Sci, 2013, 334(1-2):164-166.
[34] Murakami K, Tsukahara M, Tsuneoka H, et al.Catscratch disease: analysis of 130 seropositive cases[J]. J Infect Chemother, 2002, 8(4):349-352.
[35] Puligheddu M, Giagheddu A, Genugu F, et al.Epilepsia partialis continua in catscratch disease[J]. Seizure, 2004, 13(3):191-195.