急性播散性脑脊髓炎的临床、影像及预后分析

Clinical analysis and MRI features of acute disseminated encephalomyelitis

目的探讨急性播散性脑脊髓炎的临床和神经影像学特点。方法回顾性分析6例急性播散性脑脊髓炎患者的起病诱因、临床表现、影像特点、治疗及预后。结果 6例患者(男5例,女1例)平均起病年龄(24.3±12.7)岁,均有前驱感染史诱因。临床表现多样,很大程度取决于多发病灶的范围和部位,包括意识障碍或行为异常、头痛、肢体瘫痪、共济失调、复视、视力下降、高热。MRI均表现为颅内多发、斑片状病灶,T1加权低信号,T2加权高信号,病灶无强化。经激素治疗,总体预后较好。其中2例为复发。结论急性播散性脑脊髓炎是急性中枢神经系统脱髓鞘疾病,及时确诊、尽早应用激素等治疗,一般预后良好,甲基泼尼松龙联合静脉丙种球蛋白冲击治疗ADEM优于单用地塞米松。

Objective To investigate the clinical and MRI features of acute disseminated encephalomyelitis （ADEM）. Methods The clinical and MRI features of 6 patients with ADEM were analysed, including the trigger factors, clinical manifestations, MRI features, treatment and prognosis. Results All the 6 patients with the average age of （24. 3 ± 12. 7 ） had the history of prodromal viral infections. The clinical manifestations were variable and depended on location and size of the lesions. The change of consciousness and behavior, headache, paresis of limbs, epilepsy, diplopia and fever were the common symptoms. By means of MRI, there were bilateral, asymmetrical, patchy lesions in all eases and no enhancement in 5 cases. After treated by methylprednisolone, the overall prognosis for these patients was good. Conclusion ADEM is demyelinating disease affecting CNS. In general, its prognosis is good if the correct diagnosis was made at its early stage and the treatment of methylprednisolone was promptly introduced.