Sequential MR Studies of a Patient with White Matter Disease Presenting Psychotic Symptoms: ADEM Versus Single-Episode MS

系列磁振造影影像研究以精神症狀表現之大腦白質病變深入探討急性瀰漫性去髓鞘腦脊髓病變以及多發性硬化症

林文瓊(Wen-Chiung Lin) ； 凌憬峰(Jiin-Feng Lirng) ； 張豐基(Feng-Chi Chang) ； 陳行素(Shing-Su Chen) ； 羅兆寶(Chao-Buo Luo) ； 鄧木火(Michael Mu-Huo Teng) ； 姜仁惠(Jen-Huey Chiang) ； 張政彥(Cheng-Yen Chang)

《The Kaohsiung Journal of Medical Sciences》 17卷3期 (2001/03) Pp. 161-166

https://doi.org/10.6452/KJMS.200103.0161

摘要

本病例報告為一位三十九歲急性瀰漫性去髓鞘腦脊髓病的女性病患，在臨床上以不尋常的精神症狀表現，並且整個病程的時程長達四個月，較一般經驗上的急性瀰漫性去髓鞘腦脊髓病變之病程要來的長。起初這位病人的臨床症並非典型急性瀰漫性去髓鞘腦脊髓病變之表現，且影像檢查以及生化檢查與多發性硬化症難以作區別；但是經過一連串為期兩年的磁振造影影像的追蹤發現並無新生之大腦白質病灶，再加上臨床上病程對於類固醇治療有很好的反應，因此最後的急性瀰漫性去髓鞘腦脊髓病變之診斷得以確立。雖然許多文獻報導急性瀰漫性去髓鞘腦脊髓病變與急性期的多發性硬化症難以區分，但是至少半年以上的磁振造影影像的追蹤可以提供鑑別診斷此兩種疾病的証據，並對於病人的預後可以得到一有效良好的評估。

並列摘要

Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both demyelinating white matter disorders. It is difficult to differentiate ADEM from single episode MS because of the similar clinical presentation, cerebral spinal fluid (CSF) analysis, histological finding and magnetic resonance image (MRI) appearance. We report and ADEM case with unusual clinical presentations of predominant psychiatric symptoms, and relatively long disease course. Initially, we were not able to distinguish it from single episode MS. By means of sequential MR images followed up 2 years and spectroscopy studies, and the dramatic clinical improvement after corticosteroid therapy, ADEM was diagnosed as the disease entity of this patient. In this case report we will present the MR findings of this patient and discuss the differentiation between the ADEM and MS.

並列關鍵字

psychotic symptom；acute disseminated encephalomyelitis；multiple sclerosis；magnetic resonance image