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The Clinical Characteristics of Acute Dissemiinated Encephalomylitis

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Tutor: WangJian
School: Chongqing Medical University
Course: Neurology
Keywords: Acute disseminated encephalomyelitis,Clinicalpresentations,Magnetic resonance im
CLC: R744.3
Type: Master's thesis
Year:  2013
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Objective: To retrospectively investigate the clinical presentations andneuroimaging findings in patients with acute disseminatedencephalomyelitis, and differences between adult and children, and tosummarize the diagnosis and treatment strategy.Methods: A retrospective review and telephone follow-up of26patientswith ADEM was carried out. We analyzed their general information, clinicalmanifestations, diagnosis,treatment and prognosis;and summarize thediagnosis and treatment strategy based on literatures review. The differencebetween adult and children of ADEM patients is unclear. We exploredwhether the age of patients determine the clinical and neuroimagingpresentations. IBM SPSS Statistics18.0for Windows was used for statisticalanalysis.Results: The age range of26patients was1.67-50years old,8cases ofadult patients (mean age,29.3years old, male/female0.33),18cases ofchildren patients (mean age,5.2years old, male/female1.25), pediatricpatients occurred in winter and spring were13/18(72.2%).13/18(72%)children and4/8(50%) adult with prodromal infection or vaccination history. 80.8%acute onset,11.5%subacute onset,7.7%chronic onset. The firstsymptom is more for movement disorders, seizures, encephalopathy.Compared with the children with the first symptom,“headache, dizziness,dizziness”is more common in adult (P=0.008). Nervous system symptomsand signs includ the common non-specific symptoms (96.2%),encephalopathy (76.9%), movement disorders (73.1%), pathologicalsyndrome (69.2%), cranial nerve involvement (46.2%). In4cases (15.4%)of patients with respiratory failure. More common in children isencephalopathy (88.9%), fever (83.3%), seizures (44.4%), adult commonrepresentative manifested as headache symptoms (75%), movementdisorders (50%), sensory disturbance (50%). The clinical manifestations indifferent age groups and gender groups, showed no statistical differences.CSF more than normal,2cases of oligoclonal bands were negative. Theabnormal rate of brain CT examination for6/13(46.2%). Large brainlesions on MRI multiple ill-defined, T2WI and FLAIR showed high signal,T1WI inconspicuously, intracranial lesions in the white matter (80.77%).6patients with enhanced MRI showed no enhancement. MRI lesions andclinical symptoms in most patients with ADEM at the same time, but a "lag"case. The positive rate of nerve electrophysiological examination were EEG95.5%, VEP80%, BAEP60%, SEP38.5%, NCV100%. First blood routineexamination of69.2%normal, abnormal white cells showed mild tomoderate elevation. Misdiagnosed disease is intracranial infection,intracranial space-occupying, GBS, sepsis, cerebral infarction, lowpotassium paralysis, up to intracranial infection (76.9%). Of23cases treatedwith glucocorticoid pulse therapy,3cases of hemorrhage of digestive tract,12patients were given hormone combined with intravenousimmunoglobulin. Discharge of23/26(88.5%) clinical improvement, anaverage of1.39years,18/26(69.2%) fully recovered,4cases got themovement disorder.Conclusions: Often in prodromal infection or vaccination background,acute or subacute CNS multifocal diffuse damage, combined with thechange of the clinical features and imaging, and the exclusion of otherdiseases, the diagnosis of ADEM can be made. The clinical diagnosticcriteria of IPMSSG proposed emphasize encephalopathymanifestation,which can lead to missed diagnosis,through long-termfollow-up confirmed the clinical value. This study found no significantdifference between adult and children of ADEM patients of clinicalmanifestation.
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