儿童急性播散性脑脊髓炎42例临床分析

Clinical observation of acute disseminated encephalomyelitis in 42 children

目的总结儿童急性播散性脑脊髓炎的临床特征。方法回顾性分析42例急性播散性脑脊髓炎患儿的临床资料。结果 42例患儿中脑型39例,脊髓型3例;发病前有上呼吸道感染36例,疫苗接种史4例,无明显诱因者2例;临床表现为发热8例,抽搐17例,嗜睡5例,昏迷7例,性格改变15例,头痛、呕吐19例,语言障碍8例,肢体功能障碍7例,排便困难3例,脑神经受累7例;脑膜刺激征阳性14例,病理征阳性35例,肌张力增高8例;脑脊液检查异常32例,正常10例;42例均行头颅MRI检查,其中39例出现异常信号,3例无异常;16例行脊髓MRI检查,3例表现异常;应用糖皮质激素治疗后治愈37例,5例留有后遗症。结论感染和疫苗接种是儿童发生急性播散性脑脊髓炎主要诱因,MRI对其诊断有重要价值,早期应用糖皮质激素治疗可改善预后。

Objective To discuss the clinical characteristics of pediatric acute disseminated encephalomyelitis. Methods The clinical data of acute disseminated encephalomyelitis were retrospectively analyzed in 42 children. Results In 42 patients, 39 were cerebral type and 3 were cervical type; 36 had upper respiratory infection history, 4 had vaccination history and 4 had no obvious causes; fever occurred in 8, convulsion in 17, coma in 7, personality changes in 15, headache and vomiting in 19, language disorder in 8, limb dysfunction in 7, defecate difficulty in 3 and cerebral nerve and cerebral nerve involvement in 7; meningeal positive irritation flex was found in 14, positive pathological signs in 35, hypermyotonia in 8, abnormal results of cerebral fluid examination in 32, and normal in 10. In 43 cases undergoing cranial MRI scan, 39 were abnormal and 3 were normal. In 16 cases undergoing spinal fluid MRI scan, 3 were abnormal. In these 42 cases, 37 were cured after glucocorticoid treatment, and 5 had sequela. Conclusions Infection and vaccination are the main causes of acute disseminated encephalomyelitis. MRI plays an important role in the diagnosis. Early application of glucocorticoid can improve the prognosis.