急性播散性脑脊髓炎12例临床分析

The analysis on 12 cases of acute disseminated encephalomyelitis

目的探讨急性播散性脑脊髓炎临床特点及治疗原则。方法回顾1990年5月-2010年12月住院治疗且诊断明确的急性播散性脑脊髓炎患者临床资料,结合文献分析其临床表现、实验室检查及影像学特点。结果共12例患者符合入组条件,男性10例,女性2例,年龄6～69岁(中位年龄34.50岁)。其中9例发病前出现前驱感染症状如上呼吸道感染(6例)或无诱因发热(3例),以及诱发因素如麻疹疫苗接种史(1例)或麻疹病史(1例)。临床主要表现为发热,恶心、呕吐,头痛,神经系统症状与体征以脑神经受累(展神经常见),瘫痪(偏瘫、截瘫、四肢瘫),感觉异常,膀胱功能障碍[尿失禁和(或)尿潴留],脑膜刺激征阳性,以及不同程度意识障碍为主。大剂量糖皮质激素冲击疗法或人血丙种球蛋白静脉注射治疗有效。结论尽管急性播散性脑脊髓炎发病凶险,但早期明确诊断及鉴别诊断,及时治疗,可明显改善患者预后。

Objective To study the clinical features and treatment of acute disseminated encephalomyelitis （ADEM）. Methods All patients admitted with ADEM during May 1990 to Dec 2010 were included in the study. Clinical data of 12 cases with ADEM were reviewed and analysed. The diagnosis of ADEM was made based on the clinical presentation, suggestive MRI and auxiliary examination findings. All patients were treated with intravenous steroids or immunoglobulins （IVIg）. Results The sample consisted of 10 men and 2 women. The oldest patient was 69 years old and the youngest was 6 years old. Six patients had definite upper respiratory tract infection preceded the onset of neurological symptoms, 3 patients had non-specific fever, 1 patient had measles vaccination, 1 patient had measles prior to the onset 4 months ago. No preceding illness and vaccination occurred in 1 patient. The common presenting symptoms were fever, nausea, vomiting, headache. Neurological manifestations included cranial nerve involvement （the abdueent nerve was the most common cranial nerve involved）, paralysis （include hemiplegia, quadriplegia, paraplegia）, altered sensorium, bladder involvement （both incontinence and retention）, meningeal irrigation sign and conscious disturbance. Conclusion Despite the serious manifestation, ADEM in patient has good immediate outcome. Early diagnosis and treatment should be emphasized.