Acute disseminated encephalomyelitis - A follow-up study of 40 adult patients

被引:337
作者
Schwarz, S [1 ]
Mohr, A [1 ]
Knauth, M [1 ]
Wildemann, B [1 ]
Storch-Hagenlocher, B [1 ]
机构
[1] Univ Heidelberg, Dept Neurol, D-69120 Heidelberg, Germany
关键词
D O I
10.1212/WNL.56.10.1313
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives: To describe the clinical, CSF, and radiologic findings and long-term follow-up in a cohort of patients with acute disseminated encephalomyelitis (ADEM), and to determine possible prognostic factors for progression to MS. Methods: Forty adults (28 women, mean age 33.5 years) diagnosed with ADEM were analyzed. Clinical symptoms, cranial MRI and CSF findings, and the response to a standardized treatment during the acute phase of the disease were analyzed by chart review. The final diagnosis of ADEM or clinically definite MS was established upon follow-up examination after 8 to 137 months. The patients with ADEM and MS were compared to detect differences between the two groups. Results: Fifteen patients had a preceding infection (n = 14) or immunization (n = 1). The most frequent clinical signs were motor deficit (80%), followed by sensory deficits, brainstem signs, and ataxia. CSF findings were highly variable; normal results were present in 20% of patients. Oligoclonal bands were positive in 65% of patients. Ninety-five percent of all patients improved during the acute phase of the disease. Upon follow-up, 14 patients had developed clinically definite MS. Of the 26 patients with the final diagnosis of ADEM, two patients had died, nine had minor deficits, three had moderate deficits, and 12 patients had no remaining symptoms. Patients with the final diagnosis of ADEM were older, and more often had a preceding infection, clinical signs of brainstem involvement, a higher CSF albumin fraction, and infratentorial lesions. Conclusions: Many patients initially diagnosed with ADEM develop clinically definite MS upon long-term followup. The authors found no useful diagnostic criteria for the differentiation of a first episode of MS from monophasic ADEM. The term ADEM may still be employed as a description of a clinical syndrome, but should not be used as a distinct entity until reliable diagnostic criteria have been developed.
引用
收藏
页码:1313 / 1318
页数:6
相关论文
共 39 条
[1]   RECURRENT ENCEPHALOMYELITIS IN CHILDHOOD [J].
ALCOCK, NS ;
HOFFMAN, HL .
ARCHIVES OF DISEASE IN CHILDHOOD, 1962, 37 (191) :40-&
[2]  
Apak RA, 1999, J CHILD NEUROL, V14, P198
[3]   MR DIAGNOSIS OF ACUTE DISSEMINATED ENCEPHALOMYELITIS [J].
ATLAS, SW ;
GROSSMAN, RI ;
GOLDBERG, HI ;
HACKNEY, DB ;
BILANIUK, LT ;
ZIMMERMAN, RA .
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY, 1986, 10 (05) :798-801
[4]  
BAUM PA, 1994, AM J NEURORADIOL, V15, P1275
[5]   MRI IN ACUTE DISSEMINATED ENCEPHALOMYELITIS [J].
CALDEMEYER, KS ;
SMITH, RR ;
HARRIS, TM ;
EDWARDS, MK .
NEURORADIOLOGY, 1994, 36 (03) :216-220
[6]  
Hahn CD, 2000, NEUROLOGY, V54, pA431
[7]   Encephalomyelitis-associated antimyelin autoreactivity induced by streptococcal exotoxins [J].
Jorens, PG ;
VanderBorght, A ;
Ceulemans, B ;
Van Bever, HP ;
Bossaert, LL ;
Ieven, M ;
Goossens, H ;
Parizel, PM ;
Van Dijk, H ;
Raus, J ;
Stinissen, P .
NEUROLOGY, 2000, 54 (07) :1433-1441
[8]   ACUTE DISSEMINATED ENCEPHALOMYELITIS - MRI FINDINGS AND THE DISTINCTION FROM MULTIPLE-SCLEROSIS [J].
KESSELRING, J ;
MILLER, DH ;
ROBB, SA ;
KENDALL, BE ;
MOSELEY, IF ;
KINGSLEY, D ;
DUBOULAY, EPGH ;
MCDONALD, WI .
BRAIN, 1990, 113 :291-302
[9]   MULTIPHASIC DISSEMINATED ENCEPHALOMYELITIS PRESENTING AS ALTERNATING HEMIPLEGIA [J].
KHAN, S ;
YAQUB, BA ;
POSER, CM ;
ALDEEB, SM ;
BOHLEGA, S .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1995, 58 (04) :467-470
[10]   Serial magnetic resonance imaging in children with postinfectious encephalitis [J].
Kimura, S ;
Nezu, A ;
Ohtsuki, N ;
Kobayashi, T ;
Osaka, H ;
Uehara, S .
BRAIN & DEVELOPMENT, 1996, 18 (06) :461-465