Tsai M L, Hung K L
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, Republic of China.
Brain Dev. 1996 Sep-Oct;18(5):412-4. doi: 10.1016/0387-7604(96)00038-1.
We report a case of multiphasic disseminated encephalomyelitis (MDEM) following viral illness presenting as multiple sclerosis (MS) in a 7-year-old boy. The patients had two episodes of alternating hemiparesis and other neurologic symptoms following viral infection, which were separated by 3 years. Neuroimaging studies demonstrated multiple, discrete, small nodules and large globular lesions in the cerebral white matter, basal ganglia, brainstem and cerebellar areas. Based on typical appearance of magnetic resonance imaging (MRI) and clinical manifestations including systemic symptoms such as fever, nausea, vomiting, headache and seizures followed by consciousness disturbance and other multifocal neurologic signs, the diagnosis of MDEM rather than that of MS was made. Because it is difficult to differentiate between MDEM and MS on the basis of the clinical history, the cerebrospinal fluid examination and evoked potential studies, this report emphasizes that the MRI study of the brain may provide an important clue for the diagnosis.
我们报告一例7岁男孩在病毒感染后出现多相性播散性脑脊髓炎（MDEM），表现为多发性硬化症（MS）。该患者在病毒感染后有两次交替性偏瘫及其他神经症状发作，间隔3年。神经影像学研究显示，在脑白质、基底神经节、脑干和小脑区域有多个离散的小结节和大的球状病变。基于磁共振成像（MRI）的典型表现以及包括发热、恶心、呕吐、头痛和癫痫发作等全身症状，随后出现意识障碍和其他多灶性神经体征的临床表现，诊断为MDEM而非MS。由于根据临床病史、脑脊液检查和诱发电位研究难以区分MDEM和MS，本报告强调脑部MRI研究可能为诊断提供重要线索。
