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

Diagnosis of acute disseminated encephalomyelitis and multiple sclerosis in childhood and their differential diagnosis

Objective Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both common demyelinating diseases of the central nervous system(CNS). This paper was to study the clinical and lab test features of ADEM and MS so as to improve clinical and differential diagnosis.Methods The clinical features and experimental results were analyzed in 34 cases with ADEM and 17 cases with MS compatible with the established criteria.Results ADEM cases included 19 boys and 15 girls and MS cases 7 boys and 10 girls. Certain clinical features were helpful to differentiate ADEM and MS, such as fever (64.7 %;29.4 %), headache (58.8 %;23.5 %), consciousness change ( 64.7 %;5.9 %) including coma (17.6 %;0 %); and seizures (35.3 %;0 %). ADEM often produced widespread CNS disturbance, but MS usually presented monosymptomatic syndrome, such as 6 cases of myelopathy,5 hemiplegia , and 33 optic neuritis, etc. It was impossible tomake a certain distinction on CSF immunological examinations. Cranial MRI revealed thalamic involvement (ADEM 32.4 %; MS 0 %); ADEM and EMG examination showed peripheral nerve damage in ADEM whereas not any in MS.Conclusion It is suggested that ADEM be considered in the patients presenting previous history of an infection or vaccination, widespread CNS disturbance and alteration of consciousness or seizures in particular, and multifocal white matter lesion on MRI especially with thalamic involvement and that MS be considered with onset of monosymptomatic syndrome, at least two non-associated lesions in white matter, and relapses and remittence.