Abstract
Enterovirus (EV) genarally causes hand-foot-and-mouth disease which resolves spontaneously, but is sometimes followed by a fatal central nervous system infection. The authors have experienced a pediatric case of acute EV 71 brainstem encephalitis. A three-year-old male child was admitted to our ICU in a state of severe consciousness disturbance (JCS 300), after suffering from fever, abdominal pain, and vomiting for several days. T2-weighted magnetic resonance imaging showed hyperintensity in the brainstem. Treatment with pressure- regulated volume-controlled ventilation, and intermittent infusions of glycerol and γ globulin were immediately initiated. However, circulatory collapse and pulmonary edema occurred suddenly on the 2nd ICU day, and brain edema on brain CT and slowing of electroencephalographic activity were aggravated. After initiating steroid administration and mild hypothermia therapy (3 days, esophageal temperature 34-35°C), brain edema was gradually improved. Administration of TRH seemed to further improve consciousness (JCS 20), and he was transferred to the pediatric ward on the 46th ICU day. In the treatment of EV brainstem encephalitis, continuous vigilance and management of cardiopulmonary function and the suppression of secondary neuronal injury caused by an elevated inflammatory reaction are important. Mild hypothermia therapy may exert an inhibitory effect on the development of secondary neuronal injury related to excitotoxicity and the cytokine mechanism.
