急性播散性脑脊髓炎的临床及实验室研究

A clinical and experimental study of acute disseminated encephalomyelitis

目的探讨急性播散性脑脊髓炎（ADEM）病因、分类与分型、临床及实验室检查的特点，提高诊断与鉴别诊断能力。方法制定较严格的诊断标准，对符合标准的34例地DEM的临床表现及实验室检查进行分析。结果34例中感染后脑脊髓炎30例，接种后脑脊髓炎4例。临床呈脑型表现16例，脑脊髓型18例。脑脊液异常12／34例，IgG指数增加16／24例。EEG异常23／31例及BAEP（5／10例）、SEP（6／8例）和VEP（3／6例）异常。脑MRI是多发性病灶31倒（91．2％），其中较时称性的17例；34例病变部位大脑白质27例，脑干11例，小脑7例，丘脑11例，基底节6例。脊髓MRI异常4／7例。结论对有前驱感染或接种史呈脑炎我脑脊髓炎表现者，脑脊液（CSF）检查排除细菌、病毒等感染，若MRI示脑白质多发性病灶改变应考虑ADEM。

To study the etiology,category,clinical and lab test features of acute disseminated encephalomyelitis (ADEM) so as to improve the clinical and differential diagnosis.Methods The clinical features and experimental results were analysed in 34 patients with ADEM compatible with the established strict diagnostic criteria.Results ADEM was studied in a series of 34 patients , including 3o cases of postinfectious encephalomyelitis(PIE) and 4 postvaccinal encephalomyelitis (PVE ). Clinically, 16 had presentations of the brain and 18 of the brain and spinal cord. Abnormal CSF and high index of IgG were detected in 12/24 and 16/24 respectively. There were abnormal findings on EEG in 23/31 patients, as well as on BAEP (5/10), SEP (6/8) and VEP (3/6). Cranial MRI revealed multi focal lesions in 31, including relatively symmetric lesions in 17. MRI in 34 demonstrated the involvement of various areas of cerebral white matter (27), brainstem (11), cerebellum (7 ) , thalamus (11 ) and basal ganglia (6). Spinal cord MRI also showed abnormal singnals in 4 of 7.Conclusions It is suggested that ADEM be considered in the patients presenting clinically as encephalitis or encephalomyelitis after infections or vaccinations, and viral and bacterial infections can be excluded by CSF examinations,provided that MRI shows mutifocallesions of white matter.