Sonneville R, Klein I, de Broucker T, Wolff M
Department of Critical Care Medicine and Infectious Diseases, Bichat-Claude Bernard Hospital, Université Paris 7, 46 Rue Henri Huchard, 75877 Paris Cedex 18, France.
J Infect. 2009 May;58(5):321-8. doi: 10.1016/j.jinf.2009.02.011. Epub 2009 Apr 14.
Many important central nervous system (CNS) syndromes can develop following microbial infections. The most severe forms of post-infectious encephalitis include acute disseminated encephalomyelitis (ADEM), acute hemorrhagic leukoencephalitis and Bickerstaff's brainstem encephalitis. ADEM is an inflammatory demyelinating disorder of the CNS. It typically follows a minor infection with a 2-30 days latency period and is thought to be immune-mediated. It is clinically characterized by the acute onset of focal neurological signs and encephalopathy. Patients can require intensive care unit admission because of coma, seizures or tetraplegia. Cerebrospinal fluid analysis usually shows lymphocytic pleocytosis but, unlike viral or bacterial encephalitis, no evidence of direct CNS infection is found. There are no biologic markers of the disease and cerebral magnetic resonance imaging is essential to diagnosis, detecting diffuse or multifocal asymmetrical lesions throughout the white matter on T2- and FLAIR-weighted sequences. High-dose intravenous steroids are accepted as first-line therapy and beneficial effects of plasma exchanges and intravenous immunoglobulins have also been reported. Outcome of ADEM is usually favorable but recurrent or multiphasic forms have been described.
许多重要的中枢神经系统（CNS）综合征可在微生物感染后发生。感染后脑炎最严重的形式包括急性播散性脑脊髓炎（ADEM）、急性出血性白质脑炎和比克斯特法夫脑干脑炎。ADEM是一种中枢神经系统的炎症性脱髓鞘疾病。它通常在轻微感染后出现，潜伏期为2至30天，被认为是免疫介导的。其临床特征为局灶性神经体征和脑病的急性发作。由于昏迷、癫痫发作或四肢瘫痪，患者可能需要入住重症监护病房。脑脊液分析通常显示淋巴细胞增多，但与病毒性或细菌性脑炎不同，未发现直接中枢神经系统感染的证据。该疾病没有生物学标志物，脑磁共振成像对于诊断至关重要，在T2加权和液体衰减反转恢复（FLAIR）加权序列上可检测到整个白质中的弥漫性或多灶性不对称病变。大剂量静脉注射类固醇被公认为一线治疗方法，血浆置换和静脉注射免疫球蛋白的有益效果也有报道。ADEM的预后通常良好，但也有复发性或多相性形式的报道。
