A 16-year-old Japanese girl presented with left hemiparesis and coma, following a 2-day history of headache and fever. She had been previously well and no history of a skin wound. MR scan of the brain showed a 6 cm lesion in the right frontal white matter with mass effect and slight edge enhancement (figure 1). A craniotomy was performed for external decompression and brain biopsy. The intraoperative finding was of white matter necrosis rather than tumour or abscess. An interim biopsy showed prominent neutrophil infiltration and fibrinoid necrosis in small vessels but no evidence of a specific pathogen. We suspected either a central nervous system infection or an autoimmune disease such as acute disseminated encephalomyelitis, and so started antibiotics and pulsed corticosteroids in the intensive care unit. Figure 1 MR scan of brain on admission showing a mass lesion in the right frontal lobe. The fluid-attenuated inversion recovery (FLAIR) image …

中文翻译：

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类似于急性播散性脑脊髓炎的阿米巴脑炎

一名 16 岁的日本女孩，因头痛和发烧 2 天的病史而出现左侧偏瘫和昏迷。她以前身体很好，没有皮肤伤口的病史。脑部 MR 扫描显示右侧额叶白质有 6 cm 的病灶，有占位效应和轻微边缘强化（图 1）。进行了开颅手术以进行外部减压和脑活检。术中发现是白质坏死而不是肿瘤或脓肿。中期活检显示小血管中有明显的中性粒细胞浸润和纤维素样坏死，但没有证据表明存在特定病原体。我们怀疑是中枢神经系统感染或自身免疫性疾病，如急性播散性脑脊髓炎，因此在重症监护病房开始使用抗生素和脉冲皮质类固醇。图 1 入院时脑部 MR 扫描显示右额叶有肿块。流体衰减反转恢复 (FLAIR) 图像……