脑卒中样多发性硬化24例临床治疗分析

Stroke Sample Analysis of 24 Cases of Multiple Sclerosis Clinical Treatment

目的：探讨并分析脑卒中样多发性硬化的临床特点及治疗手段。方法：对我院2009年2月-2012年8月收治的24例（男11例,女13例）脑卒中样多发性硬化患者进行观察分析,所有患者的诊断标准均以国际多发性硬化诊断专家小组推荐的Poser为主。并将24例患者分为地塞米松组和甲泼尼龙组,两组分别采用地塞米松常规治疗和甲泼尼龙冲击治疗。患者服药终止后对两组患者采用延伸残疾状况评估表（Expanded Disability Status Scale,EDSS）进行神经行为学评分,同时测定MS影响评分（Multiple Sclerosis Impact Scale,MSIS）。结果：从起病方式来看,亚急性起病患者所占比重较大,发病症状较为多样,发病诱因以感冒发热和疲劳饮酒为主。1个月后地塞米松组的EDSS评分高于甲泼尼龙组,而MSIS评分则低于甲泼尼龙组。结果提示脑卒中样起病的MS患者应尽早治疗,并根据病情特点实施有效的方法进行诊治,防止延误患者的病情。结论：对于脑卒中起病的MS患者应该注意脑卒中样MS的鉴别并及早进行MRI检查和FLAIR成像及增强扫描,磁化传递成像（MTR）对于鉴别脱髓鞘病变和脑卒中具有一定的价值。使用甲泼尼龙进行激素冲击治疗效果较好, MSIS评分有较为明显的提高,而EDSS评分也明显低于地塞米松组。

Objective：To investigate the clinical characteristics and treatment methods and analysis of brain stroke like multiple sclerosis.Methods：24 patients in our hospital in 2009 February-2012 year in August the （male 11 cases,female 13 cases） were observed and analyzed stroke and multiple sclerosis patients,all patients were recommended to the diagnostic criteria of multiple sclerosis diagnosis expert team of Poser standard.And 24 cases were divided into treated group and methylprednisolone group,two were used conventional therapy of dexamethasone and methylprednisolone pulse therapy.Patients in the medication after termination of two groups of patients with extended disability status scale （Expanded Disability Status Scale,EDSS） to score of neurological behavior,simultaneous determination of MS （Multiple Sclerosis Impact Scalescore,MSIS）.Results：From the mode of onset,subacute onset patients accounted for a larger proportion,the symptoms are various,the inducement to cold and fever and fatigue drinking.After January the dexamethasone group were higher than those of the EDSS methylprednisolone group,and MSIS score were lower than methylprednisolone group.The results suggest that stroke onset MS patients should be treated as soon as possible,and according to the characteristics of the implementation of effective methods of diagnosis and treatment,prevent the delay of the patient.Conclusion：For stroke onset of MS patients should pay attention to MS identified stroke and as soon as possible and FLAIR for MRI imaging and enhanced scan,magnetization transfer imaging （MTR） for differentiating demyelinating lesions and cerebral apoplexy has a certain value.Using methyl prednisolone for hormone shock treatment effect is good,MSIS score is evident in the rise,and EDSS score was significantly lower than the dexamethasone group.