ABSTRACT
Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.
ABSTRACT
Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence ( or = 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Age of Onset , Alopecia/diagnosis , Alopecia Areata/diagnosis , Dermatitis, Atopic/diagnosis , Family Health , Nail Diseases/diagnosis , PrognosisABSTRACT
Treatments for alopecia areata include topical corticosteroid treatment, corticosteroid intralesional injection, systemic corticosteroid treatment, PUVA(psoralen-UVA) and topical immunotherapy. The therapeutic effects are variable. Alopecia totalis is hard to treat completely. Topical immunotherapy with dinitrochlorobenzene (DNCB), squaric acid dibutyl ester (SADBE) or diphenylcyclopropenone (diphencyprone, DPCP) represents the most accepted therapeutic modality for the treatment of extensive alopecia areata. We report two cases of alopecia totalis treated with DPCP. After DPCP treatment, total scalp hair was completely recovered.
Subject(s)
Alopecia Areata , Alopecia , Dinitrochlorobenzene , Hair , Immunotherapy , Injections, Intralesional , ScalpABSTRACT
A case is described, where and adolescent boy developed alopecia areata and alopecia totalis during the course of routine orthodontic treatment for the resolution of a dentoalveolar Class II division 1 malocclusion. The orthodontic treatment lasted 22 months, with a successful outcome. However, within eight months of the onset of treatment the patient lost all his hair. Exhaustive medical tests and differential diagnosis determined that the etiolgy of the patient's alopecia was psychological stress evoked by the orthodontic treatment. Numerous reports suggest that psychological stress can cause alopecia by affection the immune system. Therefore, it appears reasonable to assume that in the case of this patient, alopecia had resulted from stress effects on the immune system, leading to autoimmune disease-like conditions in tissues surrounding the scalp hair follicles. The alopecia condition was successfully reversed by daily oral and topical applications of vitamin D. It is concluded that the immune system plays a pivotal role in tissue remodeling around the teeth and elsewhere in the body, and conditions capable of affection this system may cause unfavorable outcomes, such as alopecia.
Subject(s)
Adolescent , Humans , Male , Alopecia Areata , Alopecia , Diagnosis, Differential , Hair , Hair Follicle , Immune System , Malocclusion , Scalp , Stress, Psychological , Tooth , Vitamin DABSTRACT
BACKGROUND: Alopecia totalis and alopecia universalis are uncomman and developed from 5-10% of the patients with alopecia areata. OBJECTIVE: The authors perfcirmed a study for clinical obervations and the effects of treatments of alopecia totalis and alopecia universalis in order that this study may cointribute to further studies and treatments of them. MEHTODS: The author performed a clinical study of 42 patients with alopecia totalis and alopecia universalis retrospectively in order to evaluate the clinical manifestation. and the effects of treatments from January 1984 to March 1992 at the department of Dermatology, College of Medicine, Chung Ang University. RESULTS: 1. The incidence of alopecia totalis and alopecia universalis was 6.7% (42/623) among the alopecia patients who were occtipied 1.4% (623/44,839) among the all new dermatologic out patients. 2. The age distributions at the onset of disease showed a peak incidenced an age of less than 15 years (52.4%, 22/42) and the average age was 19.7 years. 3. The laboratory fi ndings showed decreased total T cell count in 1 case(1/10), inversed T/T ratio in 6 cases(6/10), poisitive anti-thyroglobulin anti-body in 3 cases(3/11), and abnormal serum levels of testosterone, esradiol and progesterone in 5 cases(5/22), 2 cases(2/14) and 8 cases(8/13), respectively. 4. The effects in the group treated with topical immunotherapy with DPCP(2,3-diphenylcyclopropenone) or DI CB(2,4-dinitrochlorobenzene) revealed no significant difference from those in the group treated with an intralesional injection of triamcinolone acetonide. 5. The response rates to treatment were make ily higher in the patients with alopecia totalis than alopecia uriiversalis, in cases where the duration of disease was less than 5 years, and in the patients associated with psychologic stress. CONCLUSION: These results suggested that alopecia totalis and alopepia aniversalis frequently occur in children, and some of them we eassociated with cell mediated immunity defects, autoantibody and endocrine factors. The patients with alopecia totalis, with short duration if disease and associated with emotional stress showed better therapeutic responses.
Subject(s)
Child , Humans , Age Distribution , Alopecia Areata , Alopecia , Cell Count , Dermatology , Immunity, Cellular , Immunotherapy , Incidence , Injections, Intralesional , Outpatients , Progesterone , Retrospective Studies , Stress, Psychological , Testosterone , Triamcinolone AcetonideABSTRACT
Authors tried methyl-prednisolone pulse therapy in 12 cases of severe cases of alopecia areats(eight cases of alopecia totalis, two cases of alopecia universalis, and two cases of alopecia subtotalis) by the assumption that administration of corticosteroid by pulse method minimize its side effects and maximize its therapeutic effect. Authors followed the courses of therapeutic result of the 12 cases for at least one year after finishing t.he treatment. The results were as follows : 1. The overall evaluation of the treatment showed four cases with excellent response, one case with good response, one case with disappointed response and six cases with no response. 2. The responses of the therapy appeared to be dependent on the duration of the alopecia areata ; the better the response is, the shorter the duration of the alopecia is. Most cases shorter than 6 months duration of alopecia showed excellent response. 3. Side effects of the treatment were as follows ; facial flushing(12/12), intermenstrual spotting(4/7), weight gain(4/12), moon face(3/12), acneiform eruption(1/12), exacerbation of hypertension (1/12). Those side effects did not keep any patient from the planned treatment.