儿童多发性硬化的临床特征及治疗随访

目的 探讨儿童多发性硬化(multiple sclerosis,MS)的临床特征及治疗效果,以提高诊治水平.方法 回顾分析15例儿童多发性硬化患儿的临床特征及治疗随访情况.结果 15例多发性硬化患儿中,男8例,女7例;急性和亚急性起病14例(93.3%);起病年龄为2.5岁～11岁,平均(7.43±2.83)岁;其中复发-缓解型12例,继发-进展型3例.常见首发症状为视力下降9例(60.0%),共济失调6例(40.0%),肢体瘫痪6例(40.0%).11例患儿行MRI检查,均异常,5例显示空间多发.9例患儿长期随访2年3个月～16年,均有3～7次复发.结论 儿童多发性硬化发病率明显低于成人,起病年龄多在10岁以下,以视神经受累多见,强化MRI检查对MS的诊断极为重要;急性期应用激素及静脉丙种球蛋白治疗有效.     

视神经脊髓炎的临床特点及预后分析

目的探讨儿童视神经脊髓炎(NMO)的临床特点及预后,以提高对此病的认识。方法研究对象为1997年4月-2010年5月在本院住院确诊的7例NMO患儿,对其临床表现、实验室及影像学检查、治疗及预后进行回顾性分析。结果 7例NMO患儿均为首次确诊病例。男2例,女5例,男女比例为1.03.5。起病年龄1岁5个月～15岁,中位年龄10岁。病前有感染史5例。首发症状为视神经炎3例,脊髓炎4例。视神经炎与脊髓炎间隔时间1 d～7个月,中位时间8 d。单侧视神经炎2例,双侧视神经炎5例。脊髓横贯性损害5例,不完全横贯性损害2例。视觉诱发电位(VEP)检查异常7例。脊髓MRI检查示胸段病灶7例,同时累及下颈段、腰骶段各1例;病灶长度4～11个脊髓节段,中位值7个脊髓节段。头颅MRI检查异常1例。自身抗体检查异常1例。脑脊液检查细胞数增高3例,均以淋巴细胞为主,病原学检查(-)。7例患儿急性期均静脉滴注甲泼尼龙冲击后改为口服泼尼松治疗,3例患儿同时静脉滴注丙种球蛋白。除1例患儿放弃治疗外,余6例病情均有恢复。跟踪随访的4例患儿中,2例复发,复发症状表现为仅视神经炎或脊髓炎与视神经炎均出现。结论儿童NMO可于幼儿期发病,部分有缓解复发的阶梯病程,应注意临床病灶的早发现及随访。     

儿童多发性硬化的临床特点及治疗

目的探讨儿童多发性硬化（MS）的临床特点及治疗,以提高其诊治水平。方法对1993年6月至2006年5月我科收治的25例MS患儿的临床资料及随访情况进行分析。结果本组25例,女性16例,男性9例,男：女：1：1．78。其中复发-缓解型21例,继发进展型3例,1例未明确分型。平均起病年龄6．7岁（2～12岁）。以视力障碍为首发症状者11例;以皮层症状为主者8例,包括惊厥、意识障碍、失语、失用等;脊髓病变3例;脑干病变2例;小脑性共济失调1例。起病时有发热者10例。表现为神经系统单一部位病变者9例,多部位者16例。病程中有视力障碍者19例,视诱发电位异常22例（88％）。平均病程8．5年（1．2—17．2年）,复发次数0～4次（0次者为随访期间无新的临床发作）。结论MS在儿童期少见,有其不同于成人的特点。女性多于男性,以视神经炎多见,起病急且病程短,常见不典型脱髓鞘疾病症状。头颅MRI提示白质病变是不可缺少的诊断标准之一。脑脊液寡克隆区带阳性率低于成人,与成人MS相比较少遗留神经系统后遗症,其中以视神经萎缩,视力障碍为常见。急性期激素和IVIG治疗有效。     

视神经脊髓炎谱系疾病患儿的临床及影像学特征北大核心CSCD

目的探讨视神经脊髓炎谱系疾病（NMOSD）患儿的临床及影像学特征。方法回顾性分析2013年7月至2017年9月山东大学附属省立医院小儿神经科收治的16例NMOSD患儿的临床资料、影像学表现及随访资料。结果16例患儿中首发症状为视神经炎（ON）5例,长节段横贯性脊髓炎（LETM）6例,ON及LETM同时发生者3例,初诊为急性播散性脑脊髓炎者2例。11例患儿行血清水通道蛋白-4（AQP4）抗体检查,4例阳性;7例患儿同时行脑脊液AQP4抗体检查,1例阳性。14例ON患儿中11例行视神经磁共振成像（MRI）检查,8例显示视神经、视交叉异常信号,部分有强化。13例LETM患儿行脊髓MRI检查,显示为长节段（长度5～13个椎体节段）炎性病灶,颈段1例,胸段3例,颈段＋胸段9例,其中2例颈段向上波及延髓。15例患儿行颅脑MRI检查,均显示有颅内病灶,主要分布于大脑半球中央及皮质下白质、丘脑、胼胝体、脑干、脊髓延髓交界处、小脑等。患儿急性期均予大剂量甲泼尼龙和/或丙种球蛋白治疗,症状均得到明显改善。2例ON复发患儿应用利妥昔单抗治疗后视力明显改善。随访15例患儿,2例存在肢体活动障碍,4例残留视力障碍,其余无临床症状。结论儿童NMOSD早期临床表现多样,首次诊断为急性脊髓炎、ON、急性播散性脑脊髓炎者,需考虑有无NMOSD的可能,检测AQP4抗体有助于明确诊断。NMOSD患儿典型的影像学特点为AQP4高表达区域的异常信号。急性期治疗推荐大剂量甲泼尼龙和丙种球蛋白,对于多次复发患儿可应用利妥昔单抗。     

儿童多发性硬化84例临床研究

目的 探讨儿童多发性硬化（multiple sclerosis,MS）临床特点、治疗及预后,以提高其诊治水平。方法　回顾性分析1993年11月至2014年12月北京大学第一医院儿科84例住院MS患儿临床资料及随访情况进行总结。结果　84例主要临床表现为视力下降、无力、头痛、发热、脑病症状、惊厥。脑脊液寡克隆区带阳性率为28.2%,抗髓鞘少突胶质细胞糖蛋白抗体阳性率为32.7%。头颅磁共振成像（MRI）示92.9%存在皮质下白质脱髓鞘、 86.9%存在脑室旁白质病变、47.6%小脑病变、36.9%脑干病变、29.8%基底节病变、21.4%丘脑病变、16.7%胼胝体病变。急性期均给予糖皮质激素治疗,53例合用大剂量丙种球蛋白,69例首次发作治疗后完全缓解。随访0.7～22.0年,平均复发次数（4.71±3.18）次,平均年复发（0.65±0.52）次/年,61例在首次发病1年内复发。57例随访至2014年12月,12.3%有运动异常,29.8%有视力下降,39.6%有学习障碍。结论　10岁内发病的MS并不少见,常以视力下降、无力、头痛、 发热、脑病、惊厥为首发症状;脑脊液寡克隆区带阳性率低;MRI显示皮质下、脑室旁白质病变多见;急性期糖皮质激素治疗有效,多在1年内复发,疾病修正治疗（DMT）可延长复发间隔,视力下降与学习障碍为其常见的后遗症。     

儿童朗格罕细胞组织细胞增生症BRAFV600E突变对预后的影响

目的 探讨BRAFV600E突变在儿童朗格罕细胞组织细胞增生症（LCH）中的预后意义以及影响儿童LCH的预后因素。方法 回顾性纳入首都医科大学附属北京儿童医院2016年1月1日至2017年12月31日收治的初治LCH患儿,采用数字PCR方法检测患儿病灶组织中的BRAFV600E突变,分析突变与临床特征和预后的相关性,影响预后的因素。结果 140例LCH患儿纳入研究,诊断时中位年龄为2.2（0.1~15.7）岁,男89例（63.6%）,女51例。临床分型为单系统（SS）60例（42.9%）,多系统无危险器官受累（MS RO－）47例（33.6%）,多系统有危险器官受累（MS RO+）33例（23.6%）。中位随访时间34.1（0.9~50.7）月,随访期内70例（50.0%）出现进展或复发,12例（9.6%）出现持续性后遗症,死亡3例（2.1%）。总体3年无进展生存率（PFS）、无事件生存率（EFS）和总生存率（OS）分别为（48.9±4.5）%、（46.6±4.4）%和（97.8±1.2）%。①儿童LCH中BRAFV600E突变阳性率67.1%（94/140）。②BRAFV600E突变与患儿临床分型明显相关,突变阳性率MS RO+患儿（90.9%）高于MS RO－患儿（53.2%）或SS患儿（65.0%）（P=0.001）;皮肤受累患儿中突变阳性率（77.8%）高于非皮肤受累的患儿（P=0.042）;③BRAFV600E突变阳性患儿进展/复发率（57.4%）高于突变阴性患儿（34.8%）,P=0.019。3种临床分型中突变阳性和阴性患儿的预后差异均无统计学意义。④多因素分析结果表明,危险器官受累是影响LCH患儿PFS的独立预后因素（HR=2.702,P=0.003）,垂体受累（HR=3.582,P<0.001）、危险器官（HR=2.321,P=0.008）和耳部受累（HR=2.093,P=0.013）是EFS的独立预后因素。结论 LCH患儿BRAFV600E突变与危险器官受累密切相关,突变阳性患儿的进展/复发率高于突变阴性患儿,BRAFV600E不是儿童LCH的独立预后因素。     

5岁以上神经母细胞瘤患者的临床特点及疗效分析

目的 总结5岁以上神经母细胞瘤（NB）患儿的临床特点及疗效,为改善其预后提供理论基础。方法 回顾性分析54例初治NB患儿临床资料,进行临床特点、疗效总结以及Kaplan-Meier生存分析。结果 54例患儿中男36例、女18例,均为3、4期。以腹膜后占位最多见（76%,41/54）,其次为纵隔占位（18%,10/54）、椎管内占位（4%,2/54）和盆腔占位（2%,1/54）。截止至随访日期,54例患儿中存活30例（56%）：无病生存23例（77%,其中9例为复发再度化疗后完全缓解）、肿瘤部分缓解6例（20%,均为复发再度化疗患儿）、进展1例（3%,为复发再度化疗后进展）;死亡24例（44%）,其中22例为复发再度化疗后死亡、2例为初治期间多脏器衰竭死亡;治疗、随访期间共38例复发。Kaplan-Meier生存分析提示：54例患儿平均生存时间53.8个月;3期患儿总生存率（OS）为80%,高于4期患儿（53%）,差异具有统计学意义（P < 0.01）;复发患儿平均生存时间（51.68个月）低于无复发病例（62.57个月）,差异有统计学意义（P < 0.01）。结论 年长儿NB临床分期多属晚期,但规律治疗仍可提高疗效,应增加患儿信心,坚持规范治疗。     

急性脑部炎症合并视觉障碍患儿22例临床特征及预后

目的 分析急性脑部炎症合并视觉障碍患儿临床特征及预后。方法 对2003年1月至2014年6月中国医科大学附属盛京医院小儿神经内科22例临床诊断为急性脑部炎症合并视觉障碍患儿的临床症状、实验室检查、视觉诱发电位、神经影像学特点等临床资料进行回顾性分析。结果 发病＜1周就诊入院的10例、1～2周8例、＞2～4周2例、＞4周2例。以视觉障碍首发就诊的7例。确诊为病毒性脑炎合并视神经炎9例,病毒性脑炎合并视神经乳头炎1例,病毒性脑炎及化脓性脑膜炎合并视觉障碍性质待定各1例,播散性脑脊髓炎合并视神经炎的2例,脑干脑炎合并暴露性眼炎的1例,病毒性脑炎合并右眼晶体点状混浊、双眼视网膜发育不良的1例,视神经脊髓炎1例,病毒性脑炎合并皮质盲1例,播散性脑脊髓炎合并视乳头炎、疑似小柳原田综合征1例,多发性硬化症可能性大3例。全部患儿均进行了视觉诱发电位检查,其中视觉传导通路异常18例。10例行眼底照相,结果异常7例。均行头磁共振（MR）平扫检查,结果异常10例,其中6例脑内病变范围广泛。18例行丙种球蛋白联合激素冲击治疗,其中出院时14例视觉障碍症状好转。出院后随访6个月至8年,20例预后较好、2例预后较差。结论 急性脑部炎症合并视觉障碍病因多样,除考虑常见病,如视神经炎、视神经乳头炎、视神经脊髓炎、脑血管病外,还应考虑到少见疾病,如皮质盲、小柳原田综合征等。早期行视觉诱发电位、眼底照相检查对于疾病诊断与鉴别有意义,积极治疗对改善预后有重要作用。     

儿童慢性炎性脱髓鞘性多发性神经病15例报告并文献复习

目的：探讨儿童慢性炎性脱髓鞘性多发性神经病(CIDP)的临床特点和预后。方法：收集2008年1月至2017年1月复旦大学附属儿科医院收治的CIDP患儿的临床资料,检索PubMed数据库1991年1月至2017年2月的儿童CIDP病例,将文献检索和本文的病例汇总,根据到达疾病高峰期时间分组,4~8周为亚急性起病组,＞8周为慢性起病组,比较两组的临床表现、实验室检查、治疗和预后。结果：①符合本文纳入和排除标准的CIDP患儿15例,男6例,女9例;1～3岁4例,～7岁4例,～15岁7例;起病年龄1岁1月至11岁9月;7例有前驱感染史;到达疾病高峰期时间为4周至13月,平均（12.9±13.6）周。15例的首发症状均为运动障碍,4例有感觉障碍;疾病高峰期改良Rankin量表（MRS）评分：3分8例,4分6例,5分1例;病程呈单向型3例,进展型5例,复发型7例;15例神经传导检查均有神经源性损害,脑脊液检查均有细胞蛋白分离现象。14例予糖皮质激素治疗,1例予静脉丙种球蛋白治疗;1例家属放弃治疗出院,其余14例住院时间7~17 d,出院时临床症状均有不同程度好转。随访中7例患儿复发。②共有14篇文献报道87例CIDP患儿与本文15例合并行文献分析（n=102),亚急性起病组38例,慢性起病组64例。两组性别、起病年龄和运动障碍差异无统计学意义,感觉障碍（57.1% vs 23.5%,P=0.002）和颅神经异常（25.7% vs 7.8%,P=0.023）亚急性起病组高于慢性起病组,且更易反复发作（62.2% vs 34.0%,P=0.010）,慢性起病组单相发作形式多（50.8% vs 27.8%,P=0.026）。结论：CIDP亚急性起病患儿感觉障碍和颅神经异常多于慢性起病患儿,并且疾病发展过程中容易复发。儿童CIDP运动障碍常见,较少出现颅神经损害和呼吸衰竭等,脑脊液细胞蛋白分离现象多见,电生理改变明显,早期治疗则预后较好。     

儿童癔病性黑朦1例

儿童癔病性黑朦１例山东省济宁市第一人民医院（２７２１１１）孔玲张梅香１）孙玉敏惠颖患儿女，８岁，因右眼突然视力丧失４小时，疑似右球后视神经炎收入院。病前否认感冒、发热史。检查：左视力１．５，内外眼未发现异常。右视力无光感，角膜、瞳孔正常，直接、间接光...     

Optic neuritis in children

PURPOSE: To describe the clinical characteristics of optic neuritis in children, including final visual acuity and development of multiple sclerosis (MS). METHODS: Charts were reviewed of all patients < 15 years of age who presented with optic neuritis to the Bascom Palmer Eye Institute or the Miami Children's Hospital between 1986 and 1998. RESULTS: Fifteen patients were identified. There was a slight female predilection in the study group (60%), with a mean age of 9.8 years at presentation. A preceding febrile illness within 2 weeks of visual symptoms was reported in 66% of patients. Initial visual acuity ranged from 20/15 to no light perception. Involvement was bilateral in 66% of patients, and disc swelling was present in 64% of involved eyes. Of the patients who underwent magnetic resonance imaging, 33% had focal demyelinating lesions in the brain, and 63% of affected nerves were enlarged or enhanced with gadolinium. Eleven patients were treated with intravenous steroids. Final visual acuity was > or = 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or worse. Four (26%) patients developed MS. The mean age of patients with MS was 12 years, compared with 9 years in children who did not develop MS. Patients with unilateral involvement had an excellent visual prognosis (100% > 20/40), but a higher rate of development of MS (75%). Two patients had positive serology for Lyme disease. CONCLUSIONS: Optic neuritis presents differently in children than in adults. Children typically have bilateral involvement with papillitis following an antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children who present with unilateral involvement have a better visual prognosis; however, they also develop MS at a greater frequency than children with bilateral involvement. Patients who developed MS were, on average, older at presentation with optic neuritis than those who did not develop MS.     

Effects of smoking during pregnancy on the optic nerve neurodevelopment

Background

Tobacco smoking during pregnancy alters neurodevelopment. Optical coherence tomography (OCT) provides precise measurements of the retinal nerve fiber layer (RNFL), which forms part of the central nervous system.

Aims

To assess using the OCT how smoking during pregnancy would affect optic nerve development as detected in human offspring.

Study design

Visual examination and OCT were performed on a group of children (n = 70; 4.15-13.50 years of age), classified as being exposed or not to maternal smoking during gestational period. The association between smoking during pregnancy and RNFL thickness was assessed by a linear regression analysis adjusted for possible confounding factors.

Results

Although visual outcomes did not differ between groups, a significant decrease in the RNFL thickness was found in the group of infants exposed to smoke (105.3 vs 95.6; p = 0.002), even when adjusting for gestational age, birth weight or gender.

Conclusions

OCT measurements show that intrautero exposure to tobacco smoke interferes with the development of the optic nerve.     

Thickness of the retinal nerve fiber layer, macular thickness, and macular volume in patients with strabismic amblyopia

OBJECTIVE: To compare the thickness of the retinal nerve fiber layer (RNFL), the macular volume, and the macular thickness of the amblyopic eye with those of the non-amblyopic eye in patients with unilateral strabismic amblyopia using optical coherence tomography (OCT). PATIENTS AND METHODS: OCT was performed for 14 patients with unilateral strabismic amblyopia who had no neurologic disease. Nine male and 5 female patients, whose ages ranged from 5 to 18 years, were enrolled in the study. The RNFL thickness average analysis program was used to evaluate mean superior, inferior, temporal, and nasal thickness. The data for all clock quadrants (12 values averaged) were identified as the overall RNFL. The retinal thickness and volume analysis program was used to evaluate macular scans. Data were compared using the Mann-Whitney U test. RESULTS: The mean age (+/- standard deviation) was 10.43 years (+/- 4.09 years). There were 6 right eyes and 8 left eyes with amblyopia; this group had a mean visual acuity (+/- standard error) of 0.3 (+/- 5.70). OCT parameters including the RNFL thickness in all quadrants, overall RNFL thickness, macular thickness, and macular volume showed no significant differences between the two groups (P > .05). CONCLUSION: Assessment of RNFL thickness, macular thickness, and macular volume with OCT revealed no difference between the two eyes of patients with unilateral strabismic amblyopia.     

Safety and efficacy of mitoxantrone in pediatric patients with aggressive multiple sclerosis

ObjectiveThe purpose of this study was to assess the safety and efficacy of mitoxantrone (MX) in pediatric patients with aggressive multiple sclerosis (MS).MethodsA retrospective analysis on pediatric MS patients treated with MX was performed with regards to demographic/clinical parameters and magnetic resonance imaging (MRI) findings.Results19 definite pediatric MS cases with mean ± SD age of 15.4 ± 2.8 years underwent 20 mg MX for control of their severe/frequent relapses, high EDSS score or new and active brain MRI lesions. After a median [IQR] follow-up period of 30[12–60] months, 14 cases (73%) were relapse free; the EDSS score decreased by at least 0.5 in 16 cases (84.2%); and gadolinium-enhancing lesion volume fell by 84.2% in 16 cases. Adverse events included nausea and vomiting, fatigue, alopecia, palpitation, cardiomyopathy and mild leukopenia. All adverse events were mild and transient.ConclusionOur results suggest MX is a good candidate for treatment of children with worsening RRMS and SPMS. Recommendations regarding patient selection, treatment administration, and close follow-up should be considered. Continuing research is needed to establish its efficacy and safety profile in a multinational collaboration with careful follow-up of adverse events.     

Optic neuritis in Asian children

PURPOSE: To study the clinical spectrum of pediatric optic neuritis in Korean children. METHODS: A retrospective analysis was performed on 23 patients with onset of the disease before the age of 16 years from 1995 to 2000. The degree of initial visual loss, subsequent visual recovery, magnetic resonance images, and associated diseases was reviewed. RESULTS: There was no female predilection in the study group (43%) with a mean age of 8.9 years at presentation. Involvement was bilateral in 87% of patients. A preceding febrile illness within 2 weeks of visual symptoms was reported in 39% of patients. Of the 43 involved eyes of 23 patients, disc swelling was present in 51%, and central/cecocentral scotoma in 58% of the involved eyes. With a mean follow-up of 14 months, 79% of the patients had final vision of > or =20/40. Twenty-four (96%) of 25 eyes with intravenous steroid treatment and 10 (56%) of 18 eyes without intravenous steroids showed final visual acuity > or =20/40. Only 1 patient (4%) with multifocal signal abnormalities around the periventricular white matter developed multiple sclerosis. CONCLUSION: Korean children with optic neuritis showed bilateral involvement with papillitis. The visual prognosis was relatively good and especially better in the patients receiving intravenous steroid treatment than in those without any treatment; however, this study is not controlled. Although a longer follow-up period is required, the development of multiple sclerosis is rare in Korean children with optic neuritis.     

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??Abstracts?? Objective To analyze the clinical characteristics and prognosis of acute encephalitis with visual impairment in children. Methods The clinical features?? including clinical manifestations??laboratory tests??Flash visual evoked potential and cranial MRI?? in 22 patients diagnosed with acute encephalitis with visual impairment in children were retrospectively analyzed. Results The disease course was less than one week in 10 cases. The disease course of eight cases was between one week and two weeks?? two cases were between two weeks and four weeks?? two cases were over four weeks. Seven cases had visual impairment as the first symptom. One case was with the diagnosis of viral encephalitis with cortical blindness. Nine cases were with the diagnosis of viral encephalitis with optic neuritis. One case was with the diagnosis of encephalitis with neuropapillitis. One case was with the diagnosis of disseminated encephalomyelitis with optic neuritis. Two cases were with the diagnosis of disseminated encephalomyelitis with optic neuritis. One case was with the diagnosis of brainstem encephalitis with exposure keratitis. One case was with the diagnosis of encephalitis with lens opacity and retinal dysplasia. One case was with the diagnosis of ophthalmoneuromyelitis. One case was likely with the diagnosis of Vogt-Koyanagi-Harada syndrome. In all the cases of Flash visual evoked potential??eighteen were abnormal. In the ten cases of fundus photography??seven were abnormal. In all the cases of cranial MRI??ten were abnormal and six suffered from extensive pathological changes in the brain. In the eighteen cases of hormone therapy??fourteen had good effects. The time of post hospitalization follow-up ranged from 6 months to 8 years. The prognosis of 20 patients was good. Two patients’ prognosis was bad. Conclusions There are different kinds of etiology and diseases in children who are diagnosed with acute encephalitis with visual impairment. Flash visual evoked potential and fundus photography are of important significance in the early stages. High doses of IVIG corticosteroids and hyperbaric oxygen therapy play a key role in improving the prognosis of disease.     

Childhood optic neuritis: The pediatric neurologist's perspective

BackgroundOptic neuritis in children may be an isolated, usually postinfectious event, or the symptom of a more widespread disorder.AimTo investigate the etiological spectrum of optic neuritis in children in association with diagnostic findings and follow-up results.MethodsWe retrospectively examined the records of 31 children aged 4–15 (mean 9.7 ± 2.9) years in whom isolated optic neuritis was the presenting neurological symptom.ResultsMonophasic bilateral optic neuritis was the most common presentation (45%), followed by the unilateral (32%) and recurrent (22%) forms. Initial cranial MRI was abnormal in 12/31 patients. During a mean follow-up of 2.2 years (6 months–15 years), 6/14 bilateral cases, 9/10 unilateral and 5/7 recurrent cases were diagnosed with various disorders including total eight with MS. The MS group tended to start with unilateral optic neuritis, was older (mean 11.6 ± 1.5 vs. 8.8 ± 2.9 years), and included more girls than the other groups.ConclusionsOptic neuritis in children is frequently part of a systemic or neurological disorder even in the presence of normal cranial imaging. These patients should be evaluated and followed-up in pediatric neurology clinics.     

急性播散性脑脊髓炎与多发性硬化的诊断及鉴别诊断

目的 根据急性播散性脑脊髓炎（ＡＤＥＭ）和多发性硬化（ＭＳ）临床及实验室检查特点，探讨二者的诊断和鉴别诊断。方法 制定较严格的诊断标准，对符合标准的３４例ＡＤＭ和１７例ＭＳ的临床表现及实验室检查分析比较。结果 ＡＤＥＭ３４例，男１９例，女１５例；ＭＳ１７例，男７例，女１０例。ＡＤＥＭ与ＭＳ起病发热（６４．７％；２９．４％）；头痛（５８．８％；２３．５％）；意识障碍（６４．７％；５．９％），其中昏迷