Pidcock F S, Krishnan C, Crawford T O, Salorio C F, Trovato M, Kerr D A
Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
Neurology. 2007 May 1;68(18):1474-80. doi: 10.1212/01.wnl.0000260609.11357.6f.
To relate clinical characteristics associated with acute transverse myelitis (ATM) in children with functional outcomes at follow-up.
We identified 47 patients for whom ATM occurred under the age of 18 years. Chart analysis, clinical evaluation, and administration of functional measures were completed.
The age at onset clustered between ages 0 to 2 and 5 to 17. Febrile illness had occurred in 47% and vaccination in 28%. Major disability at the nadir of the clinical course was noted. Eighty-nine percent were unable to walk, required assisted ventilation, or both. At a median of 3.2 years after acute illness, 43% were unable to walk 30 ft and 21% required a walker or other support, 68% experienced urinary urgency, 50% required bladder catheterization, 54% were troubled by persistent dysesthesias, and 75% had numbness. Factors associated with a better functional outcome included older age at time of diagnosis, shorter time to diagnosis, lower sensory and anatomic levels of spinal injury, absence of T1 hypointensity on spinal MRI obtained during the acute period, lack of white blood cells in the CSF, and fewer affected spinal cord segments. Neither rapid progression to maximum impairment in less than 1 day nor any antecedent illness, immunization, or trauma was associated with a worse outcome.
Persisting disability was present in many children with acute transverse myelitis. Urinary problems and sensory symptoms were the most common issues. Age at onset below 3 years was associated with worse functional outcomes.
探讨儿童急性横贯性脊髓炎（ATM）的临床特征与随访时功能预后的关系。
我们确定了47例18岁以下发生ATM的患者。完成了病历分析、临床评估和功能测量。
发病年龄集中在0至2岁和5至17岁之间。47%的患者曾患发热性疾病，28%的患者曾接种疫苗。临床病程最低点出现严重残疾。89%的患者无法行走、需要辅助通气或两者皆需。急性病后中位3.2年时，43%的患者无法行走30英尺，21%的患者需要助行器或其他支撑，68%的患者有尿急症状，50%的患者需要膀胱插管，54%的患者有持续性感觉异常，75%的患者有麻木感。与较好功能预后相关的因素包括诊断时年龄较大、诊断时间较短、脊髓损伤的感觉和解剖平面较低、急性期脊髓MRI未出现T1低信号、脑脊液中无白细胞以及受累脊髓节段较少。在不到1天内迅速进展至最大损伤以及任何前驱疾病、免疫接种或创伤均与较差预后无关。
许多急性横贯性脊髓炎儿童存在持续残疾。泌尿系统问题和感觉症状是最常见的问题。发病年龄低于3岁与较差的功能预后相关。
