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时间:2020-05-03
《儿童急性播散性脑脊髓炎42例临床分析.pdf》由会员上传分享,免费在线阅读,更多相关内容在应用文档-天天文库。
1、中华实用诊断与治疗杂志2014年7月第28卷第7期JournalofChinesePracticalDiagnosisandTherapy·689··论著·儿童急性播散性脑脊髓炎42例临床分析陈凤民(郑州大学人民医院河南省人民医院儿科,郑州450003)摘要:目的总结儿童急性播散性脑脊髓炎的临床特征。方法回顾性分析42例急性播散性脑脊髓炎患儿的临床资料。结果42例患儿中脑型39例,脊髓型3例;发病前有上呼吸道感染36例,疫苗接种史4例,无明显诱因者2例;临床表现为发热8例,抽搐17例,嗜睡5例,昏迷7例,性格改变15例,头痛、呕吐19例,语言障碍8例,肢体功能障碍7例,排便困难
2、3例,脑神经受累7例;脑膜刺激征阳性14例,病理征阳性35例,肌张力增高8例;脑脊液检查异常32例,正常1O例;42例均行头颅MRI检查,其中39例出现异常信号,3例无异常;16例行脊髓MRI检查,3例表现异常;应用糖皮质激素治疗后治愈37例,5例留有后遗症。结论感染和疫苗接种是儿童发生急性播散性脑脊髓炎主要诱因,MRI对其诊断有重要价值,早期应用糖皮质激素治疗可改善预后。关键词:急性播散性脑脊髓炎;儿童;糖皮质激素Clinicalobservationofacutedisseminatedencephalomyelitisin42childrenCHENFeng—min(De
3、partmentofPediatrics,People’SHospitalofZhengzhouUniversity,HenanProvincialPeopleSHospital,Zhengzhou450003,China)Abstract:ObjectiveTodiscusstheclinicalcharacteristicsofpediatricacutedisseminatedencephalomyelitis.MethodsTheclinicaldataofacutedisseminatedencephalomyelitiswereretrospectivelyanal
4、yzedin42children.ResultsIn42patients,39werecerebraltypeand3werecervicaltype;36hadupperrespiratoryinfectionhistory,4hadvaccinationhistoryand4hadnoobviouscauses;feveroccurredin8,convulsionin17,comain7,personalitychangesin15,headacheandvomitingin19,languagedisorderin8,limbdysfunctionin7,defecat
5、edifficultyin3andcerebralnerveandcerebralnerveinvolvementin7;meningealpositiveirritationflexwasfoundin14,positivepathologicalsignsin35,hypermyotoniain8,abnormalresultsofcerebralfluidexaminationin32,andnormalin10.In43casesundergoingcranialMRIscan,39wereabnormaland3werenorma1.In16casesundergoi
6、ngspinalfluidMRIscan,3wereabnorma1.Inthese42cases,37werecuredafterglucocorticoidtreatment,and5hadsequela.ConclusionsInfectionandvaccinationarethemaincausesofacutedisseminatedencephalomyelitis.MRIplaysanimportantroleinthediagnosis.Earlyapplicationofg1ucocorticoidcanimprovetheprognosis.Keyword
7、s:Acutedisseminatedencephalomyelitis;children;glucocorticoid急性播散性脑脊髓炎(acutedisseminated有上呼吸道感染病史,2例2周前接种麻腮风疫苗,1encephalomyelitis,ADEM)是以中枢神经系统急性炎例10d前接种水痘疫苗,1例1个月前注射狂犬疫苗,性脱髓鞘为特征的细胞免疫介导的自身免疫性疾病,2例无明确的感染史或疫苗接种史。ADEM诊断:主要累及脑、脊髓的白质。ADEM常发生于病毒感染(1)急性起病;
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