بررسی ویژگی‌های اپیدمیولوژیک، دموگرافیک و یافته‌های کلینیکی و پاراکلینیکی بیماران مبتلا به بیماری انسفالومیلیت حاد منتشر (ADEM) بستری شده در بیمارستان الزهرای (س) اصفهان طی یک دوره‌‌ی ده ساله (1392-1382)

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استاد، گروه داخلی اعصاب، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی‌، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: انسفالومیلیت حاد منتشر (ADEM یا Acute disseminated encephalomyelitis) یک بیماری منوفازیک با پیش‌آگهی به طور معمول خوب و یکی از تشخیص‌های افتراقی مولتیپل اسکلروزیس (MS یا Multiple sclerosis) می‌باشد. از آن جایی که بیماری MS سیر پیش‌رونده و عود کننده دارد، افتراق ADEM از MS، از اهمیت بالایی برخوردار است.روش‌ها: این مطالعه، یک مطالعه‌ی مقطعی بود که در سال 1393 در بیمارستان الزهرای (س) اصفهان انجام شد. با مراجعه‌ی پژوهشگر به واحد مدارک پزشکی، پرونده‌های بیماران ADEM در سال‌های 92-1382 از نظر اطلاعات دموگرافیک، اپیدمیولوژیک، بالینی و پاراکلینیک بررسی شد. داده‌ها با استفاده از نرم‌افزار SPSS  و آزمون‌های آماری 2χ و t مورد تجزیه و تحلیل قرار گرفت.یافته‌ها: 42 بیمار با متوسط سنی 04/10 ± 05/20 سال که اغلب (3/64 درصد) آن‌ها زن بودند، مورد بررسی قرار گرفتند. 6/78 درصد سابقه‌ی بیماری عفونی اخیر داشتند. الگوی فصلی بیماری در مجموع 62 درصد در بهار و پاییز بود. در آنالیز CSF (Cerebrospinal fluid)، به ترتیب 9/61 و 6/59 درصد، دارای پلئوسیتوز و افزایش سطح پروتئین بودند. در MRI (Magnetic resonance imaging) اولیه، بیشترین ضایعات در پری‌ونتریکولار (2/76 درصد) بود. MRI مجدد در 25 بیمار انجام شد که در 72 درصد بهبودی کامل ضایعات دیده شد. بهبودی کامل و عود، به ترتیب در 7/66 درصد و 8/23 درصد از بیماران مشاهده شد.نتیجه‌گیری: در بعضی نتایج اپیدمیولوژیک و تصویربرداری این مطالعه، با سایر مطالعات اختلاف وجود داشت. در واقع، انجام مطالعات بیشتر در زمینه‌ی تشخیص بیماری ADEM ضروری به نظر می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

The Epidemiologic and Demographic Characteristics and Clinical Findings in Patients with Acute Disseminated Encephalomyelitis (ADEM) Referred to Alzahra Hospital, Isfahan, Iran, During 10 Years (2003-2013)

نویسندگان [English]

  • Masoud Etemadifar 1
  • Farzaneh Kadkhodaei 2
  • Mohammadreza Najafi 1
1 Professor, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Acute disseminated encephalomyelitis (ADEM) is an uncommon monophasic disease often with good prognosis. It is a differential diagnosis of multiple sclerosis (MS). Accurate distinction between acute disseminated encephalomyelitis and multiple sclerosis is important for prognosis and treatment; as many patients with multiple sclerosis may benefit from early disease-modifying therapy to suppress ongoing and future relapses.Methods: In a retrograde study, all the patients presented to Alzahra hospital (Isfahan, Iran) with definite diagnosis of acute disseminated encephalomyelitis during a 10-year period were included. Demographic data, clinical signs and symptoms, and laboratory and imaging findings were collected and analyzed using t and chi-square tests via SPSS software.Findings: Forty-two patients with mean age of 20.05 ± 10.04 years and a female-predominance of 64.3% participated in the study. Thirty-three patients (78.6%) had a recent history of infectious disease. A seasonal pattern of distribution in spring (31%) and autumn (31%) was seen. The cerebrospinal fluid (CSF) analysis findings showed pleocytosis and increased protein in 26 (61.9%) and 25 (59.6%) cases, respectively. First magnetic resonance imaging (MRI) findings revealed that most of the lesions were in the periventricular (83%) and re-imaging in 25 cases showed completely or partially resolution of previous lesions with no new lesion in 18 (72%) and 7 (28%) patients, respectively.Conclusion: We found some controversies to previous studies in epidemiological and imaging studies which could be of a significant role in detecting and accurate diagnosis of acute disseminated encephalomyelitis which can significantly impact on physicians’ view of the disease.

کلیدواژه‌ها [English]

  • Acute disseminated encephalomyelitis (ADEM)
  • Multiple sclerosis (MS)
  • Differential diagnosis

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مجله دانشکده پزشکی اصفهان
دوره 33، شماره 343 - شماره پیاپی 343
مرداد و شهریور 1394
صفحه 1147-1156

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سابقه مقاله

  • تاریخ دریافت: 23 خرداد 1394
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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