妊娠初期に発症した急性散在性脳脊髄炎(ADEM)の1例

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  • A Case Report of Acute Disseminated Encephalomyelitis in the First Trimester of Pregnancy

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A 29-year-old woman was refered at 12 weeks gestation with urinary retention, constipation and paresis in bilateral upper extremities after flu-like symptoms. Ultrasonography revealed an apparently normal and appropriately grown fetus. Laboratory findings revealed an increase in the number of white blood cells (10,200/μl), counts and CRP (0.2mg/dl). Analysis of cerebrospinal fluid showed lymphocytosis and was positive for myelin basic protein. T_2-weighted magnetic resonance imaging (MRI) showed a small high spot area involving the medulla and swelling of the cervical spinal cord. Very shortly after admission, she developed progressive difficulty in breathing and had sensory deficit, as well as worsing of her upper and lower extremity weakness. These findings led to the diagnosis of acute disseminated encephalomyelitis (ADEM). She was treated with high-doses of intravenous corticosteroid, and her respiratory symptoms resolved and her upper extremity weakness was alone improved. One month later, she was able to move her arms and to eat by herself, but was not able to walk. Artificial abortion was performed at 16 weeks of gestation in order to have aggresive treatment and rehabilitation for her disease.

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