Burla Michael J, Benjamin Joseph
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan.
J Emerg Med. 2016 Feb;50(2):e53-6. doi: 10.1016/j.jemermed.2015.09.005. Epub 2015 Oct 9.
Urinary retention in an otherwise healthy adolescent is a concerning symptom, in which etiology can range from an extracystic mass to central nervous system involvement (CNS). One possibility is acute disseminated encephalomyelitis (ADEM), a rare inflammatory autoimmune disease that affects the CNS via demyelination. The disease usually is preceded by an acute viral infection, and commonly presents with multifocal neurological deficits. The diagnosis for ADEM is made based on clinical presentation, correlating with findings characterized on magnetic resonance imaging (MRI) in the CNS.
Our case involves a 16-year-old boy who presented to the Emergency Department (ED) with urinary retention. The patient was an otherwise healthy adolescent who was experiencing intermittent fevers for 1 week, and was found to be monospot positive when seen by his pediatrician. When presenting to the ED, the patient's primary complaint was urinary retention, which he experienced acutely in the middle of the night. Due to the suspicious nature of the patient's symptoms and history of present illness, the patient received a thorough workup including magnetic resonance imaging (MRI) of the patient's brain and spinal cord, which demonstrated findings consistent with ADEM. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: There is very little literature describing a case of ADEM in the ED where the primary manifesting symptom was urinary retention. In addition, it is important that clinicians address acute urinary retention in an otherwise healthy adolescent as a red flag, with the need to rule out concerning etiology.
在其他方面健康的青少年中，尿潴留是一个令人担忧的症状，其病因范围可从膀胱外肿块到中枢神经系统受累（CNS）。一种可能性是急性播散性脑脊髓炎（ADEM），这是一种罕见的炎症性自身免疫性疾病，通过脱髓鞘影响中枢神经系统。该疾病通常在急性病毒感染之前出现，并且通常表现为多灶性神经功能缺损。ADEM的诊断基于临床表现，并与中枢神经系统磁共振成像（MRI）的特征性表现相关。
我们的病例涉及一名16岁男孩，他因尿潴留就诊于急诊科（ED）。该患者是一名其他方面健康的青少年，已经间歇性发热1周，儿科医生检查时发现其嗜异性凝集试验呈阳性。就诊于急诊科时，患者的主要主诉是尿潴留，他在半夜突然出现。由于患者症状的可疑性质和现病史，患者接受了全面检查，包括脑部和脊髓的磁共振成像（MRI），结果显示与ADEM一致。为什么急诊医生应该了解这个病例？：很少有文献描述在急诊科以尿潴留为主要表现症状的ADEM病例。此外，临床医生将其他方面健康的青少年急性尿潴留视为一个警示信号很重要，需要排除相关病因。
