临床儿科杂志 ›› 2016, Vol. 34 ›› Issue (11): 815-.doi: 10.3969/j.issn.1000-3606.2016.11.004

• 神经系统疾病专栏 • 上一篇    下一篇

白质消融性白质脑病2 例报告并文献复习

丁乐, 郭虎 ,李杨 ,何燕 ,梁超 ,金波 ,卢孝鹏 ,郑帼   

  1. 南京医科大学附属南京儿童医院神经内科(江苏南京 210008)
  • 收稿日期:2016-11-15 出版日期:2016-11-15 发布日期:2016-11-15

Leukoencephalopathy with vanishing white matter: a report of two cases and literature review

DING Le, GUO Hu, LI Yang, HE Yan, LIANG Chao, JIN Bo, LU Xiaopeng, ZHENG Guo   

  1. Department of Neurology, Nanjing Children’s Hospital Affiliated to Nanjing Medical University, Nanjing 210008 , Jiangsu, China
  • Received:2016-11-15 Online:2016-11-15 Published:2016-11-15

摘要:  目的 探讨白质消融性白质脑病(VWM)的临床表现及基因表型。方法 回顾性分析经基因检测确诊的2例VWM患 儿的临床资料,并复习相关文献。 结果 2例患儿发病年龄分别为8个月、 2岁,既往精神运动发育均正常;在急性发热后出现精神 反应差,认知、运动功能进行性倒退;脑脊液检查未见异常;头颅磁共振提示两侧大脑半球脑白质对称性异常信号;基因检测1例 为EIF2B5复合杂合变异;另1例EIF2B2复合杂合变异,其中c.911_913del缺失变异导致第305号氨基酸缺失(p.305del),属于 新突变,短期内死亡。 结论 VWM早期精神、运动发育基本正常,发热后出现进行性神经系统功能倒退,预后差。EIF2B突变可确 诊。

Abstract: Objective To explore the genotype and phenotype of two patients with white matter melting leukoencephalopathy (VWM). Methods Clinical data of two children with VWM diagnosed through genetic test were retrospectively analyzed, with a review of  relevant literature. Results Onset age of the two patients were 8 months and 2 years old, respectively. Their psychomotor development were previously normal. They were with poor response after acute fever, and cognition and motor function were progressively regressed. Their cerebrospinal fluid examination was normal. Brain MRI showed symmetry abnormal signal in the hemispheres brain white matter. Genetictest found compound heterogeous mutations in EIF2B5gene in the both cases, and a c. 911_913del mutation caused deletion of 305th amino acid. Conclusions VWM was characterized by previously normal mental and motor development, and later progressive regression  after fever, and with poor prognosis. Brain MRI manifestation of the disease was widely symmetry brain white matter involvement, and gradually evolved into the same signal of cerebrospinal fluid. Mutations found in EIF2B can determine the diagnosis of  VWM.