甲基强的松龙与地塞米松在小儿急性播散性脑脊髓炎治疗中的临床疗效

目的探讨甲基强的松龙和地塞米松对小儿急性播散性脑脊髓炎患者的临床疗效。方法择取2013-01—2015-01平顶山三所收治的160例小儿急性播散性脑脊髓炎患者为研究对象,采用抛掷硬币方式将其分成2组,观察组80例,给予甲基强的松龙治疗,对照组80例,给予地塞米松治疗,比较2组疗效。结果经临床治疗和评估比较,观察组有效率为97.5%,对照组为85.0%,观察组明显高于对照组(P0.05);2组患儿治疗后的不良反应情况表现为肥胖、食欲增加等,观察组与对照组的发生率分别为27.%、25.0%,差异无统计学意义(P0.05)。结论对小儿急性播散性脑脊髓炎患者行甲基强的松龙治疗效果明显,可在各基层医院推广应用。     

儿童急性播散性脑脊髓炎21例临床分析

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。     

急性播散性脑脊髓炎8例临床分析

目的研究急性播散性脑脊髓炎(ADEM)的临床特点。方法对8例临床确诊为ADEM患者进行回顾及随访,并对临床和影像学表现等进行分析。结果(1)临床表现:5例病前有前驱感染或疫苗接种史,3例无明显诱因,神经系统症状多样。(2)影像学表现:主要累及脑白质的脱髓鞘病变,4例累及丘脑,2例累及脊髓。(3)治疗及预后:8例全用激素,其中7例予甲基泼尼松龙冲击。4例同时合用人血丙种球蛋白。8例均经6个月～2年随访,无复发,其中3例遗留后遗症。结论ADEM是一种中枢神经系统炎性脱髓鞘疾病,临床表现多样。MRI表现有一定的特征性,MRI检查有利于早期诊断,也是评价疗效的重要手段。     

急性播散性脑脊髓炎12例临床分析

目的探讨急性播散性脑脊髓炎临床特点及治疗原则。方法回顾1990年5月-2010年12月住院治疗且诊断明确的急性播散性脑脊髓炎患者临床资料,结合文献分析其临床表现、实验室检查及影像学特点。结果共12例患者符合入组条件,男性10例,女性2例,年龄6～69岁(中位年龄34.50岁)。其中9例发病前出现前驱感染症状如上呼吸道感染(6例)或无诱因发热(3例),以及诱发因素如麻疹疫苗接种史(1例)或麻疹病史(1例)。临床主要表现为发热,恶心、呕吐,头痛,神经系统症状与体征以脑神经受累(展神经常见),瘫痪(偏瘫、截瘫、四肢瘫),感觉异常,膀胱功能障碍[尿失禁和(或)尿潴留],脑膜刺激征阳性,以及不同程度意识障碍为主。大剂量糖皮质激素冲击疗法或人血丙种球蛋白静脉注射治疗有效。结论尽管急性播散性脑脊髓炎发病凶险,但早期明确诊断及鉴别诊断,及时治疗,可明显改善患者预后。     

急性播散性脑脊髓炎的护理体会

急性播散性脑脊髓炎（ADEM）是一种少见的脑脊髓弥散性损害的炎症脱髓鞘疾病，常与病毒感染、免疫接种及某些非特异性因素有关。临床主要表现为脑和脊髓弥散性损害为症状和体征。可分为脑型、脊髓型和脑脊髓型。主要症状为脑膜刺激征、脑神经麻痹、偏瘫、截瘫、大小便障碍等。因本病起病急，进展迅速，重者可危及生命，做好护理工作对降低病死率，减少后遗症十分重要。我院自1997年以来共收治急性播散性脑脊髓炎6例，现将护理体会总结如下。     

急性播散性脑脊髓炎1例报告

1临床资料患者女,38岁,工人,主因间断发热10d,2007-07-06入院。患者于入院前10d无明显诱因出现发热,体温波动在38℃~39℃,伴头痛,在当地给予抗感染治疗无好转。入院体检:T38.6℃,BP130/80mmHg,心肺腹检查(-);神经系统体检:神清语利,四肢肌力、肌张力正常,腱反射均低,病理征(-)。辅助检查:血常规WBC6.78×109/L,N64%,L24.9%;尿常规(-);肥达氏及外斐氏反应均(-);出血热抗体(-);ESR3mm/h;电解质示Na 124.4mmol/L,Cl-79.5mmol/L,K 4.4mmol/L;肝功能及肾功能均未见异常;心电图正常。考虑感染(具体原因、性质不明),给予抗感染等对症治疗,…     

急性播散性脑脊髓炎36例临床特点分析

目的阐明急性播散性脑脊髓炎(ADEM)的临床特点及诊治方法。方法分析宣武医院2003年至2010年36例ADEM住院患者的一般临床资料、临床表现、辅助检查及治疗与预后转归情况。结果本文病例多见于儿童和青壮年,急性起病,3例复发。其常见诱因为急性上呼吸道感染、疫苗接种、麻疹、风疹、水痘、流行性腮腺炎、猩红热等共计29例,原因不明7例。实验室检查中脑脊液可出现免疫球蛋白增高,磁共振成像检查提示受累部位包括脊髓、小脑、大脑白质及脑干等,其它辅助检查如电生理和免疫学检查等可协助诊断,应用糖皮质激素治疗效果确切。结论结合临床特点、神经电生理、脑脊液免疫学及影像学检查等,临床可以作出准确诊断,及时恰当的治疗对预后极为重要。     

急性播散性脑脊髓炎（附4例报告）

急性播散性脑脊髓炎（附４例报告）龚吉玲，黄益兴病例报告（摘要）例１：女性，３８岁，因双眼视物模糊１０天，进行性意识障碍加重３天入院。患者于入院前１７天和１０天接受国产已脑疫苗注射，起初视物模糊，嗣后出现进行性意识障碍，昏睡、尿失禁，入院前３天已痴呆。...     

Clinical Profiles and Short-Term Outcomes of Acute Disseminated Encephalomyelitis in Adult Chinese Patients

MethodsThis study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients.ResultsADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS).ConclusionsWith the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.     

9例急性播散性脑脊髓炎的临床和影像学分析

目的:探讨急性播散性脑脊髓炎的临床和神经影像学特点。方法:我们分析了9例急性播散性脑脊髓炎患者的起病诱因、临床表现、影像特点、治疗及预后。结果:9例患者(男3例,女6例)平均起病年龄(36.0±11.9)岁,均有疫苗接种或前驱感染史诱因。临床表现多样,很大程度取决于多发病灶的范围和部位,包括意识障碍或行为异常、头痛、肢体瘫痪、癫、高热。MRI均表现为颅内多发、斑片状病灶,T1加权低信号,T2加权高信号,仅2例患者病灶有强化。经激素治疗,总体预后较好。经过最长达4年的随访,未见有复发。结论:急性播散性脑脊髓炎可能是单相性中枢神经系统脱髓鞘病,及时确诊、尽早应用激素等治疗后,一般预后良好。     

Acute Disseminated Encephalomyelitis Confined to Brainstem

A 21-year-old man was troubled with a subacute history of brainstem involvement and a leukocyte pleocytosis in the cerebrospinal fluid. Magnetic resonance imaging (MRI) demonstrated a massive lesion with Gd enhancement in the pons. Steroid therapy, not antiviral drugs, was dramatically effective for the mass reduction and symptom improvement. Over 4 years no recurrence has been recognized, so this case was diagnosed to be an unusual case of acute disseminated encephalomyelitis (ADEM). ADEM must be included in the differential diagnosis for a brainstem mass in MRI.     

Decompressive Craniectomy for Acute Disseminated Encephalomyelitis

Background  

Acute disseminated encephalomyelitis (ADEM) is a rare, acute demyelinating condition. Although it usually presents in an acute or subacute manner over days, its clinical course may be rapid with symptoms and signs of severe intracerebral mass effect secondary to cerebral oedema.     

Acute Disseminated Encephalomyelitis Associated With Acute Toxoplasma gondii Infection

Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system, which principally affects the brain and spinal cord. It usually follows a benign infection or vaccination in children. Although a number of infectious agents have been implicated in acute disseminated encephalomyelitis, Toxoplasma gondii infection has not been described previously in children. Acquired T. gondii infection presents with lymphadenopathy and fever and usually spontaneously resolves in immunocompetent patients. We describe a previously healthy 10-year-old boy with acute disseminated encephalomyelitis associated with acute acquired Toxoplasma gondii infection, the symptoms of which initially began with nuchal stiffness, difficulty in walking, and urinary and stool incontinence; he later had development of motor and sensory impairment in both lower extremities and classical magnetic resonance imaging lesions suggestive of the disease. The patient recovered completely after the specific therapy for acquired T. gondii infection and pulse prednisolone. Although acute acquired Toxoplasma gondii infection has not been reported previously in association with acute disseminated encephalomyelitis, clinicians should keep in mind this uncommon cause of a common disease when evaluating a patient with acute disseminated encephalomyelitis.