Clinical analyses of abnormal cranial magnetic resonance imaging of 24 cases of severe hand-foot-mounth diseases complicated with brainstem encephalitis

Abstract

Objective To investigate the clinical features,treatment,prognosis,and occurrence of neurogenic pulmonary edema(NPE) in children with severe hand-foot-mouth disease (HFMD) complicated with brain stem encephalitis and abnormal cranial magnetic resonance imaging (MRI).Methods 386 cases of severe HFMD were hospitalized in our Intensive Care Unit (ICU) from May to October 2010,of which 24 cases had abnormal cranial MRI.Their clinical symptoms,MRI features,treatment,and prognosis were analyzed.Results The clinical symptoms of severe HFMD with brainstem encephalitis included fever,startle,lethargy,vomiting,difficulty swallowing,drooling,and so on.The patients with abnormal cranial MRI were prone to have a neurogenic pulmonary edema (NPE) (5％ vs 6.5％,x2 =34.55,P ＜0.01).Conclusions The nervous system-affected parts of severe HFMD is the brain stem,thalamus,and spinal cord.Brain stem inflammation can be found early by the cranial MRI to be highly vigilant of NPE.During course of 1 ～ 5 day,special attention should be paid to the symptoms of the nervous system.The early detection,timely intervention,and prevention from NPE would result in the good prognosis. Key words: Hand,foot and mouth disease/complications; Critical illness; Brain stem; Encephalitis/complications ; Magnetic resonance imaging