21例成人急性播散性脑脊髓炎临床与随访研究

Clinical and followed-up study of 21 patients with adult acute disseminated encephalomyelitis

目的探讨成人急性播散性脑脊髓炎的临床特点及转归。方法对21例成人急性播散性脑脊髓炎的临床表现及治疗转归进行回顾性分析。结果 66.7%有前驱感染或疫苗接种史,临床主要表现发热、头痛、瘫痪、尿便障碍、周围神经及神经根受累、意识障碍、癫痫等。头颅MRI可见颅内、脊髓多发异常信号,使用激素、丙种球蛋白治疗后大多病情能明显好转。0.5～1年随访,共随访14例,7例漏访,10例症状完全缓解,其余遗留有不同程度神经功能缺损。结论成人急性播散性脑脊髓炎起病急,临床表现复杂多样,对激素治疗反应较好,及时诊断治疗大多预后良好。

Objective To explore the clinical characteristics and prognosis of adult acute disseminated encephalomyelitis（ADEM）.Methods The clinical features and outcome of treatment of 21cases of ADEM were analyzed retrospectively.Results The rate of the prodromal infection or vaccination history was 66.7%.The main clinical manifestations were fever,headache,paralysis,sphincter disturbances,peripheral nerve and nerve root involvement,disturbance of consciousness,epilepsy etc.Cranial MRI could see multiple abnormal signal in intracranial and spinal cord.Most of the patients got improved significantly by the use of hormones or the gamma globulin.During the follow-up of 0.5~1 years,2 patients relapsed,10 cases had complete remission of symptoms,and the rest showed varying degrees of nerve function deficit.Conclusion Adult acute disseminated encephalomyelitis occur acutely,has a variety of clinical manifestations,and its prognosis is better by the application of hormones.The most important is timely diagnosis and treatment.