tailieunhanh - Neuroimmunology in Clinical Practice - part 5

sự hiện diện của các tế bào máu đỏ (Leake và Billman, 2002). Nghiên cứu hình ảnh tiết lộ khá xuất huyết đối xứng phân phối chất trắng sâu, một số trong đó có thể kết hợp lại thành các khu vực xuất huyết lớn phần nào không đối xứng. Đồi, dưới đồi, thân não, tiểu não và tủy sống cũng có thể tham gia, trong khi | Acute disseminated encephalomyelitis 103 Box Etiological association of acute hemorrhagic leukoencephalitis. Para-infectious . Influenza A RSV mycoplasma varicella measles and other exanthematous illnesses Postvaccination especially Pasteur rabies vaccine hepatitis B Encephalitis HSV HHV6 VZV Fungal cerebritis . Scopulariopsis phaeohyphomycosis Drug or toxin exposure . intrathecal methotrexate Blood dyscrasias . acute myeloid leukemia Fat embolism Nutritional deficiencies Ulcerative colitis Acute rheumatic fever Membranoproliferative glomerulonephritis acute tubular necrosis Asthma presence of red blood cells Leake and Billman 2002 . Imaging studies disclose fairly symmetrically distributed hemorrhages in deep white matter some of which may coalesce into large somewhat asymmetrical hemorrhagic areas. Thalami hypothalamus brainstem cerebellum and spinal cord may also be involved while cerebral cortex and basal ganglia tend to be spared. Involved tissues may be quite edematous. The disease is fulminant with death usually ensuing within hours to days. A number of reports of favorable response to high doses of intravenous corticosteroids Seales and Greer 1991 and appropriate additional treatments of increased intracranial pressure suggest that AHLE may be treatable if recognized quickly. Plasmapheresis and cyclophosphamide have also been employed with apparent effectiveness in a few cases. Rapid and effective treatment requires recognition of the presence of AHLE a diagnosis that has been confirmed in some instances by urgent brain biopsy followed by successful treatment McLeod 2001 . Craniectomy appears to have been beneficial in some cases with severe elevation of intracranial pressure. Severe cases have become rarer due to the availability and increased safety of vaccines permitting children to be effectively vaccinated against many illnesses associated with the possibility of AHLE. However small quantities of red blood cells 10-500 mm3 that are .