目的 探讨老年急性播散性脑脊髓炎(ADEM)临床与影像特征。方法 回顾性分析2013-03至2019-01解放军总医院第六医学中心神经内科15例住院老年ADEM患者的临床资料、实验室资料及影像资料。结果 男6例,女9例,年龄60~77岁,其中急性、亚急性起病分别为5例、10例;2例存在前驱诱因;首发症状:头痛与偏瘫各4例,截瘫2例,面部抽动、复视、嗜睡、腹痛和视力障碍各1例;13例头颅MR影像可见病灶。本研究中的老年ADEM患者影像表现与文献报道的儿童及中青年ADEM的头颅MRI影像相比较,并无明显差别,但本研究中部分病灶影像呈假瘤样,与中枢神经系统瘤样炎性脱髓鞘病相叠加;4/6例神经传导速度异常,高于既往文献报道中儿童和中青年ADEM患者周围神经损害发生率;随访末期,遗留中重度神经功能障碍或者死亡8例,预后较既往文献报道中儿童和中青年ADEM患者差。结论 老年ADEM前驱症候较少、起病较缓、首发症状多不典型、多累及周围神经,易误诊,预后相对较差。
Abstract
Objective To investigate the clinical and imaging characteristics of acute disseminated encephalomyelitis (ADEM) among elderly patients.Methods The clinical, laboratory and image data of fifteen elderly ADEM patients hospitalized between March 2013 and January 2019 was retrospectively analyzed.Results A total of 15 patients aged 60 to 77 were enrolled. Five of them had an acute onset and 10 a subacute onset. Among them, 2 cases had prodromal inducement. The first symptoms included headache (4 cases), hemiplegia (4 cases), paraplegia (2 cases), right facial twitch (1 case), diplopia (1 case), somnolence (1 case), abdominal pain (1 case) and visual disturbance (1 case). Head MR imaging showed lesions in 13 cases, and there was no significant difference in imaging manifestations between these elderly ADEM patients and children, middle-aged and young ADEM patients reported in the literature, but 2 cases in our study had tumefactive demyelinating lesions. Abnormal nerve conductive velocity was found in 4/6 cases, suggesting that the incidence of peripheral nerve damage in our study was higher than what was reported about younger ADEM patients in previous literature. At the end of follow-up, 8 patients were still suffering from moderate or severe neurological dysfunction or died, indicating that the prognosis was worse than what was reported about younger ADEM patients in previous literature.Conclusions Elderly patients with ADEM are characterized by fewer prodromal symptoms, milder onset, more atypical first symptoms, and more peripheral nerve involvement. They are prone to misdiagnosis and have relatively poor clinical prognosis.
关键词
急性播散性脑脊髓炎 /
瘤样脱髓鞘病变 /
核磁 /
预后
Key words
acute disseminated encephalomyelitis /
tumefactive demyelinating lesions /
magnetic resonance /
prognosis
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基金
北京市科委生物医药与生命科学创新培育研究(Z1511000 03915113)
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