儿童播散性脑脊髓炎60例临床分析

Clinical and laboratory analysis on 60 children with acute disseminated encephalomyelitis

目的:分析儿童急性播散性脑脊髓炎(Acute disseminated encephalomyelitis,ADEM)的临床和实验室特点,以提高对本病认识及早期诊断治疗。方法:对2005年1月至2007年1月重庆医科大学附属儿童医院60例ADEM患儿的临床表现、辅助检查及治疗预后进行分析。结果:60例中有前驱上呼吸道感染史者49例,疫苗接种史2例,无明显诱因9例。患儿均呈急性或亚急性起病;首发症状表现为活动障碍、意识障碍、惊厥及阵发性头痛头晕。临床主要表现为脑型30例,脑脊髓型25例,脊髓型5例。脑脊液48例异常,47例行MRI检查的患儿中43例异常,表现为脑皮质下或脊髓T1加权像呈低混合信号,T2加权像呈不均质信号或高信号。皮质激素、丙种球蛋白治疗ADEM有效。结论:儿童ADEM临床表现多样,呈多部位损害MRI表现具有一定的特征性,对本病诊断有一定的价值。

Objective： To analyze the clinical and laboratory features of children with acute disseminated encephalomyelitis （ADEM）, in order to raise awareness of this disease and improve the early diagnosis and treatment. Methods ： Clinical situation, auxiliary examination results,treatment and the prognosis of 60 children with ADEM admitted from January 2005 to January 2007 to Chongqing medical university Children＇s hospital were analyzed. Results： In the 60 cases, there were 49 casea of history of upper respiratory tract infection, 2 cases of history of vaccination,9 cases of no significant predispasition. The disease onset was acute or subacute; The first symptoms displayed disorder of the activities ,conscious disturbance, convulsions and paroxysmal headache and dizziness. The main clinical manifestations showed 30 cases of brain-type, 25 cases of brain-spinal cord, 5 cases of spinal cord type. Cerebrospinal fluid of 48 cases was abnormal, MRI examination of 43 patients out of 47 patients,the cerebral cortex or spinal cord T1-weighted imaging showed low mixed signal,T2-weighted imaging was not homogeneous signal or high signal.Therapy with corticosteroids and immunoglobulin was effective for ADEM. Conclusion：The clinical features of children ADEM were diverse,multi-site damaged. MRI has certain characteristics and is valuable for the diagnosis of ADEM.