Non-MS recurrent demyelinating diseases
Non-MS recurrent demyelinating diseases
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DOI：
10.1016/j.clineuro.2004.02.016
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发表时间：
2004-06-01
影响因子：
1.9
通讯作者：
Brinar, VV
中科院分区：
文献类型：
--
作者：
Brinar, VV
MRI的引入表明，急性、复发（R）和多相（M）形式的播散性脑脊髓炎（DEM）在成人中比怀疑的更常见，并且在大多数情况下，它们的MR图像具有足够的特征，可以与多发性硬化（MS）进行鉴别。此外，DEM的一些临床特征在MS中罕见：发热、不适、恶心、呕吐、位置性眩晕。抽搐失语症、脑膜炎、双侧视神经炎和CSF白细胞增多和蛋白升高。CSF寡克隆带通常不存在。值得注意的是，R-和MDEM和MS之间的混淆仍然存在，尽管许多已发表的报告，可追溯到70年前的经常性DEM，许多说明了特征的MRI。有许多病例报告DEM被误诊为MS、Schilder病、马尔堡病、Devic病和Balo病，特别是脑肿瘤。可能的是，急性DEM偶尔被误认为是MS的临床孤立症状。复发的可能机制包括定位在以前的神经系统损伤的部位，或分子模拟现象。由于建议在临床孤立综合征患者中开始免疫调节治疗，或当第二次临床发作确定MS诊断时，区分R-和MDEM与MS的重要性今天更大。（C）2004 Elsevier B. V.保留所有权利。
The introduction of MRI has shown that the acute, recurrent (R), and multiphasic (M) forms of disseminated encephalomyelitis (DEM) are more common than suspected in adults, and that their MR images are sufficiently characteristic in most instances to make differentiation from multiple sclerosis (MS) possible. In addition, a number of clinical features of DEM are rarely seen in MS: fever, malaise, nausea, vomiting, positional vertigo. convulsions. aphasia, meningism, bilateral optic neuritis, and CSF leukocytosis and elevated protein. CSF oligoclonal bands are usually absent. It is remarkable that confusion between R- and MDEM and MS persists despite the numerous published reports on recurrent DEM dating back 70 years, many illustrating the characteristic MRIs. There are many case reports of DEM erroneously diagnosed as MS, Schilder's, Marburg's, Devic's, and Balo's disease, and, in particular brain tumors. It is probable that acute DEM is occasionally mistaken for a clinically isolated symptom of MS. Possible mechanisms for recurrence include localization at the site of a previous injury to the nervous system, or by the phenomenon of molecular mimicry. The importance of differentiating R- and MDEM from MS is greater today due to the recommendation that immunodulatory treatment be initiated in patients with a clinically isolated syndrome, or when the occurrence of a second clinical episode establishes the diagnosis of MS. (C) 2004 Elsevier B.V. All rights reserved.