儿童急性播散性脑脊髓炎42例临床分析.pdf

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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；