Nasr J T, Andriola M R, Coyle P K
Department of Neurology; State University of New York at Stony Brook, 11794, USA.
Pediatr Neurol. 2000 Jan;22(1):8-18. doi: 10.1016/s0887-8994(99)00116-2.
Acute disseminated encephalomyelitis is a monophasic, immune-mediated disorder that produces multifocal demyelinating lesions within the central nervous system. It is characterized clinically by the acute onset of neurologic abnormalities, including varying degrees of mental state changes ranging from drowsiness to coma. It is unusual for the illness to present as an isolated acute psychosis. The case of a 14-year-old female with biopsy-confirmed acute disseminated encephalomyelitis, who was initially diagnosed with an acute psychiatric disorder, is presented, and published reports on this unusual manifestation are reviewed. A Medline database search was performed from 1965 to 1999, using the terms acute disseminated encephalomyelitis, postvaccinal encephalomyelitis, postinfectious encephalomyelitis, and measles encephalomyelitis, combined with the terms psychosis, psychiatric disorder, and behavioral disorder. Selected cross-referenced reports were also reviewed. Nine patients were identified who presented with acute psychosis. We conclude that, although rare, acute disseminated encephalomyelitis can present as an acute psychosis. This immune-mediated condition should be included in the differential diagnosis of neurologic disorders presenting as a psychiatric illness.
急性播散性脑脊髓炎是一种单相性、免疫介导的疾病，可在中枢神经系统内产生多灶性脱髓鞘病变。其临床特征为急性起病的神经功能异常，包括从嗜睡到昏迷等不同程度的精神状态改变。以孤立性急性精神病形式出现的情况较为罕见。本文报告了一例14岁女性活检确诊为急性播散性脑脊髓炎的病例，该患者最初被诊断为急性精神障碍，并对关于这种不寻常表现的已发表报告进行了综述。利用“急性播散性脑脊髓炎”“接种后脑脊髓炎”“感染后脑脊髓炎”及“麻疹脑脊髓炎”等检索词，结合“精神病”“精神障碍”及“行为障碍”等检索词，对1965年至1999年的医学文献数据库进行了检索。还对选定的交叉引用报告进行了综述。确定了9例以急性精神病形式出现的患者。我们得出结论，尽管罕见，但急性播散性脑脊髓炎可表现为急性精神病。这种免疫介导的疾病应纳入以精神疾病形式出现的神经系统疾病的鉴别诊断中。
