脑水肿是一种自身免疫疾病，可在任何炎症和感染后发生。这种疾病是高度进展的，发生在中枢神经系统[2]。这种病常发生在儿童身上。一般来说，它是非常罕见的疾病[3]的一部分。此病男性比女性多。在大多数情况下，ADEM与病毒性疾病或细菌相关或由其引起。这种疾病在某些情况下是在接种[5]疫苗后引起的。ADEM的确切发病机制尚未完全阐明。提出的ADEM机制是髓鞘自身抗原与感染性病原体[6]共享抗原性。胃痛可伴有头痛、恶心、呕吐、抽搐和失衡等症状。 A definite diagnostic method for ADEM is not yet known and it is diagnosed by MRI findings and exclusion of other diagnoses [7].
患者为一名2岁儿童，因失去意识和疑似癫痫症状而就诊于儿科急诊室。此外，该儿童在访问前12天的COVID-PCR检测报告为阳性，该儿童同时出现咳嗽和轻度发烧的症状，并同时恢复。探访时，孩子正困着。在痛苦的刺激下，他睁开了眼睛，右腿活动减少了。瞳孔中等大小，反应灵敏且对称。在随后的检查中，眼睛没有任何偏移。呕吐和角膜反射正常。孩子有自主呼吸，血压和心率正常。在孩子历史的延续中，也提到了对食物和牛奶的不耐受。患儿初始血糖正常。 After performing the initial measures, due to the unavailability of MRI, the child was subjected to brain CT scan. In the initial CT scan, the large size of the cerebral ventricles and hydrocephalus were mentioned for the child (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5 and Figure 6). Due to hydrocephalus and clinical signs of increased ICP, the child was urgently transferred to the operating room, and while measuring ICP and sending a CSF sample, a ventriculoperitoneal shunt was implanted for the child. The child's icp was measured at 32 cmH2O. After the surgery, the child's level of consciousness improved relatively. The variables of the CSF sample sent were all in the normal range. The next day, the child underwent brain MRI and MRA. In the performed MRI, a clear signal change was seen in the frontal and occipital lobes, which is shown in photos No. 2, 3, 4, 5 and 6. According to the MRI, a biopsy was taken from the child's right frontal lobe for a definitive diagnosis. Immunohistochemical examination revealed the demyelinating nature of the specimen, in which extensive infiltration of basal macrophages and activated microglial cells was seen, while axons were largely preserved. No sign of vasculitis was seen in the examination of the sample. In this way, the result of the examination of the brain sample confirmed ADEM. With this diagnosis, the child was treated with corticosteroids and IVIG. The disease responded dramatically to the treatment. All the child's symptoms improved within two days and the child's level of consciousness reached its normal range. Finally, the child was discharged from the hospital after a week with a good general condition.
Covid-19通常伴有呼吸和胃肠道症状，但在过去几年里，这种病毒也可以危险地累及中枢神经系统[8]。由于COVID-19患者很少出现中枢神经系统受累的症状，在大多数情况下，医生没有注意到这些症状。但该病例表明，检查与COVID19患者中枢神经系统受累相关的问题非常重要。考虑到ADEM的总体患病率较低，其与Covid-19的关联非常重要。考虑到ADEM疾病的总体患病率和可治疗性，另一方面，它与患病率非常高的Covid-19的关联非常重要。
该病例表明有必要调查COVID-19患者的中枢神经系统参与情况。考虑到Covid-19的传播，ADEM的发病率很可能也会增加，这就需要进行更广泛的研究。