儿童急性播散性脑脊髓炎21例临床分析

Clinical analysis of acute disseminated encephalomyelitis in 21 children

目的分析儿童急性播散性脑脊髓炎(acute disseminated encephalomyelitis,ADEM)的临床特点及辅助检查特点,以提高对此病的早期诊断及治疗。方法对2008-01—2013-05我院21例ADEM患儿的临床表现、辅助检查、治疗经过及预后进行回顾性分析。结果 21例患儿中有前驱感染病史者17例(80%),接种疫苗史2例。起病方式呈急性或亚急性起病,首发症状多样。MRI主要表现为白质受累。13例患儿脑脊液检查异常(62%),主要表现为细胞数及蛋白轻度升高。所有病例予以大剂量甲泼尼龙,12例合用大剂量免疫球蛋白,病情大多明显好转。结论儿童ADEM临床症状多样,结合MRI、脑脊液检查等多种辅助检查有助于及时明确诊断,患儿预后较好。

Objective To identify clinical features of acute disseminated encephalomyelitis（ADEM）in children in order to improve early diagnosis and therapy.Methods Clinical data from 21 children with ADEM from January 2008 to May 2013 involving clinical manifestation,auxiliary examination,treatment and prognosis were retrospectively analyzed.Results Of the selected 21 ADEM children,17 cases（80%）showed histories of prodromal infection and 2 cases had received vaccination.The onset of ADEM was relatively acute and the primary symptoms were diverse.White matter lesions presented by MRI examina-tion were found in all patients.Cerebrospinal fluid（CSF）examination was abnormal in 13 cases（62%）,which mainly performed high levels of both cell count and protein.All the patients were treated with massive dose of methylprenisolone,and 1 2 cases of＆amp;nbsp;them additionally received intravenous immunoglobulin,and as a result,most cases made good prognosis.Conclusion As clini-cal symptoms of ADEM in children are variable,combination of MRI and CSF examinations may contribute to identify diagno-sis.And most cases have benign prognosis.