One-year Follow-up Study Of Clinical And Imageological Abnormalities Of Acute Disseminated Encephalomyelitis

Objective: To explore the clinical manifestation and neuroimaging abnormalities recovery of acute disseminated encephalomyelitis(ADEM),in order to improve the ADEM clinical and imaging understanding,to diagnose and treat preferably ADEM.Methods: Neurology Department of Children's Hospital Affiliated to Soochow University received and cured 47 cases of ADEM who met diagnosis standard of ADEM and completed one-year follow-up from April 2011 to April 2015.The clinical manifestation,auxiliary examination especially neurological imaging,therapeutic method,prognosis and other data were analyzed,and its clinical and neuroimaging abnormalities recovery was summarized.Results: There were 47 cases of ADEM,including 26 girls,21 boys,and the age range was between 1 and 14 years,with the average age of 6;There were 32 cases who were sick in winter and spring;37 cases(78.72%)who had prodromic infection history,5 cases(10.64%)who had the history of vaccination.Clinical manifestations were varied,including 36 cases(76.60%)with somatic discomfort,30 cases(63.83%)with fever,24 cases(51.06%)with headache and dizziness,22 cases(46.81%)with nausea and vomiting,30 cases(63.83%)with disturbance of consciousness,28 cases(59.57%)with epileptic seizure,15 cases(31.91%)with dyskinesia,15 cases(31.91%)with cranial nerve injury,9 cases(19.14%)with incoordination;8 cases(17.02%)with mental and behavior disorder.Abnormal lesions of magnetic resonance imaging(MRI)were characterized by equal,low mixed signal on T1 weighted image,and high signal on T2 weighted image and Flair image,and MRI abnormal change on T2 weighted image and Flair image was clearer;Abnormal lesions presented multiple,asymmetric patchy and large patchy signal image,typical lesions were distributed in white matter and deep gray matter(such as the thalamus and basal ganglia),and could affect lateral ventricle periphery,centrum semiovale,frontal lobe,parietal lobe,temporal lobe,occipital lobe,basal ganglia,thalamus,brain stem,cerebellum,and etc.Some cases involved the spinal cord.There were no dead children in this group,and 16 cases were cured clinically(34.04%)when discharged;30 cases(63.83%)whose clinical symptoms improved obviously;27 cases(57.45%)with recovery time<3 months,9 cases(19.15 %)with recovery time of 3-6 months,and 5 cases(10.64 %)with recovery time>6 months.There were 4 cases(8.51%)with clinical sequelae,including 2 cases with dyskinesia,1 case with symptomatic epilepsy,and 1 case with mental retardation.In the process of one-year cranial MRI follow-up,MRI lesions of all children shrank than before in half a month,and there were 4 cases whose lesions completely disappeared(8.51%).There were 13 cases whose lesions completely disappeared(27.66%)in a month;23 cases(48.94%)whose lesions disappeared completely in three months;32 cases(68.09%)whose lesions disappeared completely in 6 months;43 cases(91.49%)whose lesions disappeared completely in one year and 4 cases who had sequela lesion.Conclusion: ADEM is the most common childhood acquired leukoencephalopathy,clinical manifestations are diverse,and nerve auxiliary examination was of great significance in the diagnosis of this disease,differential diagnosis,prognosis evaluation and recurrence,especially the cranial MRI examination.Most of ADEM long-term prognosis was good,and a few children left neurologic deficits.Imageological change appeared as clinical symptoms appeared,and disappeared as clinical symptoms improved,but it can last longer or existed permanently;At the same time,the recovery of clinical manifestation of ADEM children was often earlier than the regression of radiological lesions,lesions of most of the children could be fully recovered within a few months,and very few children could leave long-term lesions.