Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
PLoS One. 2011;6(8):e22766. doi: 10.1371/journal.pone.0022766. Epub 2011 Aug 10.
Brain stem lesions are common in patients with acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and multiple sclerosis (MS).
To investigate comparative brain stem lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, NMO, and MS.
Sixty-five adult patients with ADEM (n = 17), NMO (n = 23), and MS (n = 25) who had brain stem lesions on MRI were enrolled. Morphological features of brain stem lesions among these diseases were assessed.
Patients with ADEM had a higher frequency of midbrain lesions than did patients with NMO (94.1% vs. 17.4%, P<0.001) and MS (94.1% vs. 40.0%, P<0.001); patients with NMO had a lower frequency of pons lesions than did patients with MS (34.8% vs. 84.0%, P<0.001) and ADEM (34.8% vs. 70.6%, P = 0.025); and patients with NMO had a higher frequency of medulla oblongata lesions than did patients with ADEM (91.3% vs. 35.3%, P<0.001) and MS (91.3% vs. 36.0%, P<0.001). On the axial section of the brain stem, the majority (82.4%) of patients with ADEM showed lesions on the ventral part; the brain stem lesions in patients with NMO were typically located in the dorsal part (91.3%); and lesions in patients with MS were found in both the ventral (44.0%) and dorsal (56.0%) parts. The lesions in patients with ADEM (100%) and NMO (91.3%) had poorly defined margins, while lesions of patients with MS (76.0%) had well defined margins. Brain stem lesions in patients with ADEM were usually bilateral and symmetrical (82.4%), while lesions in patients with NMO (87.0%) and MS (92.0%) were asymmetrical or unilateral.
Brain stem lesions showed various morphological features among adult patients with ADEM, NMO, and MS. The different lesion locations may be helpful in distinguishing these diseases.
脑干部位病变在急性播散性脑脊髓炎（ADEM）、视神经脊髓炎（NMO）和多发性硬化（MS）患者中较为常见。
探讨成人 ADEM、NMO 和 MS 患者磁共振成像（MRI）上脑干部位病变的比较。
纳入 65 例 MRI 显示脑干部位病变的 ADEM 患者（n = 17）、NMO 患者（n = 23）和 MS 患者（n = 25）。评估这些疾病的脑干部位病变的形态特征。
与 NMO（94.1%比 17.4%，P<0.001）和 MS（94.1%比 40.0%，P<0.001）患者相比，ADEM 患者中中脑病变更为常见；与 MS（34.8%比 84.0%，P<0.001）和 ADEM（34.8%比 70.6%，P=0.025）患者相比，NMO 患者脑桥病变发生率较低；与 ADEM（91.3%比 35.3%，P<0.001）和 MS（91.3%比 36.0%，P<0.001）患者相比，NMO 患者延髓病变发生率较高。在脑干部位的轴位切片上，大多数（82.4%）ADEM 患者的病变位于腹侧；NMO 患者的脑干部位病变通常位于背侧（91.3%）；MS 患者的病变位于腹侧（44.0%）和背侧（56.0%）。ADEM（100%）和 NMO（91.3%）患者的病变边界不清，而 MS 患者（76.0%）的病变边界清晰。ADEM 患者的脑干部位病变多为双侧对称（82.4%），而 NMO（87.0%）和 MS（92.0%）患者的病变多为不对称或单侧。
成人 ADEM、NMO 和 MS 患者的脑干部位病变具有不同的形态学特征。不同的病变位置有助于鉴别这些疾病。
