Objective: To study the clinical features of children with acute disseminated encephalomyelitis (ADEM) and related recurrence factors.
Methods: A retrospective analysis was performed for the clinical data and prognosis of 73 children with ADEM who were hospitalized from November 2011 to January 2017.
Results: Among the 73 children, 41 (56%) had a history of infection before onset and 7 (10%) had a history of vaccination. All children had the symptoms of encephalopathy, including disturbance of consciousness in 47 children (64%) and mental and behavioral disorders in 54 children (74%). Pyrexia was observed in 53 children (73%), dyskinesia in 47 children (64%), headache in 47 children (64%) and vomiting in 40 children (55%). Brain MRI was performed for 65 children and the results showed involvement of the subcortical white matter (83%, 54/65), the deep nuclei (60%, 39/65), the brain stem (58%, 38/65) and the cerebellum (42%, 27/65). Spinal cord involvement was observed in 20 children (20/43, 47%). A total of 15 children experienced recurrence during follow-up. Compared with the non-recurrence group, the recurrence group had significantly higher percentages of children with deep nucleus involvement (P<0.05), with injury in ≥3 spinal segments (P<0.01) and with a time from disease onset to gamma-globulin/hormone treatment of >2 weeks (P<0.05).
Conclusions: ADEM in children have various clinical manifestations. A small number of children may experience recurrence. Deep nucleus involvement on MRI, long spinal segmental injury (≥3 segments) and late treatment with gamma-globulin/hormone (>2 weeks) may be associated with the recurrence of ADEM.
目的: 探讨儿童急性播散性脑脊髓炎（ADEM）的临床特征及复发因素。
方法: 回顾性分析2011年11月至2017年1月住院的73例ADEM患儿的临床资料及转归情况。
结果: 73例患儿中，发病前41例（56%）有感染病史，7例（10%）有疫苗接种史。所有患儿均具有脑病表现，其中意识改变47例（64%），精神行为异常54例（74%）；余以发热（53例，73%）、运动障碍（47例，64%）、头痛（47例，64%）、呕吐（40例，55%）等多见。头颅MRI检查以皮层下白质（83%，54/65）、深部核团（60%，39/65）、脑干（58%，38/65）、小脑（42%，27/65）受累多见。47%（20/43）患儿脊髓受累。随访发现共15例患儿复发。与未复发患儿比较，复发患儿更多出现深部核团受累（P < 0.05），≥ 3个脊髓节段损伤者更多见（P < 0.01），丙种球蛋白和/或激素治疗时间距起病>2周的比例更高（P < 0.05）。
结论: ADEM临床表现多样，少数患儿可复发。MRI深部核团受累、≥ 3个节段的长节段脊髓病变、丙种球蛋白和/或激素治疗时间较晚（>2周）可能与ADEM复发相关。