단일병원에서 경험한 소아뇌염의 임상증상과 예후
Clinical Presentation and Prognosis of Pediatric Encephalitis: Experience of a Korean Single Tertiary Center
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목적: 다양한 임상증상을 보이며 심각한 합병증 또는 사망에 이를수 있는 소아뇌염의 원인을 알고 이에 따른 진단, 치료, 그 치료 경과를 알아보고자 하였다. 방법: 2000년 1월부터 2013년 7월까지 서울아산병원에 뇌염으로입원한 소아199명을 대상으로 후향적 검토를 통해 소아뇌염의 원인질환을 확인하고 원인질환에 따라 감염성, 부감염성, 일차 염증성 뇌염으로 분류하였으며 각각의 임상양상, 검사결과, 잠정진단에 따른 치료 및 질병경과를 조사하였다. 결과: 감염성 뇌염이 전체 뇌염의 64.3%로 가장 많았으며 특정 원인균이 동정되지 않은 경우가 75% 이었다. 부감염성 뇌염은 25.1%, 일차 염증성 뇌염은 10.5%로 확인되었다. 초기 증상으로 발열(62.3%), 경련발작(52.8%), 의식변화(51.3%), 운동 이상, 두통, 구토를보였으며, 뇌척수액 내 백혈구 증가는 72.6%에서, MRI 이상은 64%에서, EEG 이상은 76.6%에서 나타났다. 68.1%에서 완치되었으며 27% 에서 후유증을 남기고 4.3%는 사망하였다. 일차 염증성 뇌염에서 완치율이 낮고(P=0.032) 합병률이 높은 경향을 보였다(P=0.039). 경련증상(OR 4.17, P=0.007), 뇌파 이상소견(OR 3.37, P=0.037)이 나쁜 예후와 관련이 있었다. 결론: 발열, 운동기능 이상, 경련, 의식변화 등의 임상증상을 보이는환자에서 뇌염을 의심하고 최근 발달한 영상 및 혈청학적 검사를 포함하는 광범위한 검사와 잠정진단에 따른 즉각적인 치료가 필요하며합병증에 대하여 정신건강의학적 평가를 포함한 지속적인 추적관찰이 필요하다.
Abstract
Purpose: This study was performed to investigate the clinical presentations, diagnostic findings and prognosis of pediatric patients with the broad definition of “encephalitis”, that is inflammation of brain, in a single Korean tertiary center. Method: We retrospectively analyzed medical records of patients who had been diagnosed with encephalitis from January 2000 to July 2013 at the Asan Medical Center Children’s Hospital. We classified encephalitis in three categories of etiology which are infectious, para-infectious and primary inflammatory. The initial presentation, radiological and electroencephalographic findings, treatments and outcomes were reviewed. Results: During the 13-year study period, we found 199 pediatric cases of encephalitis.128 (64.3%), 50 (25.1%), and 21 (10.5%) cases were classified as infectious, para infectious and primary inflammatory encephalitis, respectively. They presented with fever (62.3%), altered mentality (51.3%), seizures (52.8%) and motor dysfunction (37.7%). Specific pathogens were proven in only 32 (25%) patients from 128 infectious encephalitis. Among 185 patients who had been followed up, 127 cases (68.6%) recovered without sequela and 50 cases (27%) with sequelae. Eight cases (4.3%), six with infectious encephalitis, one with acute disseminated encephalomyelitis and the other with Reye syndrome, expired. Conclusion: Infectious etiology is suggested in a great part of the pediatric encephalitis and additional efforts are needed to find specific etiologies of encephalitis in many cases. Considering the high mortality and morbidity of the pediatric encephalitis, prompt evaluations and appropriate treatment should be implemented.
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