小儿急性播散性脑脊髓炎临床特点及疗效初探

The clinical feature and curative effect on childhood acute disseminated encephalomyelitis

目的探讨小儿急性播散性脑脊髓炎(ADEM)的临床特征和综合治疗效果。方法通过回顾总结9例患儿的临床资料及辅助检查结果,观察其治疗效果及转归。结果9例患儿中,以暴发起病者2例,以急性起病者2例,以亚急性起病者5 例。起病前1-4周7例有感染征象,1例有疫苗接种史(风疹疫苗),1例无异常前驱病史。主要临床表现有发热、乏力、头痛、呕吐、嗜睡、昏迷、抽搐、瘫痪、脊髓半切征、小脑共济失调、颅神经征阳性等。辅助检查脑脊液细胞数均正常,蛋白轻度增高1例, 寡克隆区带阳性7例,MRI异常7例(表现为半卵圆中心,丘脑,基底节,小脑,脊髓的散在,不对称的点片状的长T1长T2信号)。经综合治疗,2-5d症状缓解.经治疗4-6w,治愈7例,好转1例,死亡1例(好转及死亡的2例均为暴发起病)。结论小儿急性播散性脑脊髓炎(ADEM)的临床特点为①多与感染有关,可能为感染后的免疫反应。②起病形式多样。以亚急性起病者为多。③临床表现多样化。患儿有多处神经系统受累的症状和体征。④以糖皮质激素为主的综合治疗效果良好,但暴发起病者预后差。注意与多发性硬化,弥散性硬化,视神经脊髓炎,急性感染性多发性多神经炎相鉴别。

Objective To approach the clinical feature and curative effect on childhood acute disseminated encephalomyelitis. Methods To find out the curative effect and prognosis through review the clinical information and accessorial findings on 9 children. Results On 9 children,2 children were taken bad with eruptive,2 children were taken bad with acute,5 children were taken bad with subacute. 7 children had infect sign.1 child had vaccination history(rubella bacterin) ,1 child had nothing unconventionally. The mine clinical manifestations included:fever.tired.headache.vomit Jethargy. coma. tic.paralysis. syndrome of hemisection of the spinal cord, cerebellum ataxia..cranial nerves sign was masculine etc. accessorial findings included; In CSF ,All the cell number were natural, 1 child 's protern was light heighten and 7 children'sOB was masculine. 7 childrenMRI was unconventionality(It had messy、anisomerous 、punctate and sheet sign of long T1 and long T2 in CSo,thalamencephalon,basal nuclei,cerebella,spinal cord) .After integrative treatment, the symptom would be relaxed from 2 to 5 day,7 children were cured,1 child was straightened up and 1 child was died after 4-6wk (the 2 children who was straightened up and died were all taken bad with eruptive). Conclusion The clinical characteristic on childhood acute disseminated encephalomyelitis were ① Many of the children were in respect of infection, Perhaps it were immunoreaction after the infection.②The form of taking bad were various. Many of the children were taden bad with subacute. ③The clinical representative was diversification. The children were many symptom and sign on systema nervosum where were putting into trouble.④The effect was all right after integrative treatment with glucocorticoid hormone giving priority to. But the effect was bad with eruptive.