Brass Steven David, Caramanos Zografos, Santos Carlos, Dilenge Marie-Emmanuelle, Lapierre Yves, Rosenblatt Bernard
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
Pediatr Neurol. 2003 Sep;29(3):227-31. doi: 10.1016/s0887-8994(03)00235-2.
The initial presenting clinical and laboratory findings of either acute disseminated encephalomyelitis or the first attack of multiple sclerosis in the pediatric population were compared and contrasted. A retrospective review of the medical records was conducted of all children younger than 17 years who presented with either the diagnosis of acute disseminated encephalomyelitis or multiple sclerosis between 1987 and 2001. Seventeen cases of clinically definite multiple sclerosis (seven female, mean age 12.4 +/- 4.5 years) and seven cases of acute disseminated encephalomyelitis (three female; mean age 8.7 +/- 3.8 years) were reviewed. Systemic and nonfocal neurologic symptoms were more commonly evident in acute disseminated encephalomyelitis than in multiple sclerosis: fever (43% vs 6%), headache (57% vs 24%), fatigue (71% vs 29%), vomiting (57% vs 0%), and encephalopathy (71% vs 6%). In multiple sclerosis patients, T(2)-weighted white matter magnetic resonance imaging lesions were more commonly located in the corpus callosum (64% vs 17%) and the periventricular area (91% vs 50%) compared with those in patients with acute disseminated encephalomyelitis. These results suggest that acute disseminated encephalomyelitis and multiple sclerosis can be differentiated to some degree according to clinical and radiologic data at initial presentation, which is important because the long-term prognosis for childhood multiple sclerosis appears to be less favorable.
对小儿群体中急性播散性脑脊髓炎或多发性硬化首次发作的初始临床表现和实验室检查结果进行了比较和对比。对1987年至2001年间所有17岁以下被诊断为急性播散性脑脊髓炎或多发性硬化的儿童病历进行了回顾性研究。回顾了17例临床确诊的多发性硬化病例（7例女性，平均年龄12.4±4.5岁）和7例急性播散性脑脊髓炎病例（3例女性；平均年龄8.7±3.8岁）。与多发性硬化相比，急性播散性脑脊髓炎中全身和非局灶性神经症状更为常见：发热（43%对6%）、头痛（57%对24%）、疲劳（71%对29%）、呕吐（57%对0%）和脑病（71%对6%）。与急性播散性脑脊髓炎患者相比，多发性硬化患者的T2加权白质磁共振成像病变更常见于胼胝体（64%对17%）和脑室周围区域（91%对50%）。这些结果表明，急性播散性脑脊髓炎和多发性硬化在初次就诊时可根据临床和影像学数据在一定程度上进行区分，这很重要，因为儿童多发性硬化的长期预后似乎不太乐观。
