ABSTRACT
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating conditions, which is usually monophasic. Recurrent ADEM and multiphasic disseminated encephalomyelitis (MDEM) is much less characterized entity, and its differentiation from multiple sclerosis (MS) poses a diagnostic challenge. We report a case of multiphasic disseminated encephalomyelitis (MDEM). The patient had two episodes of paraparesis and other neurologic symptoms, which were separated by 2 months. The patient presented with fever, headache, mental change, lower extremity weakness, voiding difficulty as well as focal neurologic deficits, which showed good response on steroid and acyclovir. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement, and spine MRI revealed high signal intensity from C3 to T9 spinal cord. The CSF study showed elevated protein count and negative oligoclonal band.
Subject(s)
Humans , Acyclovir , Brain , Encephalomyelitis , Encephalomyelitis, Acute Disseminated , Fever , Headache , Lower Extremity , Multiple Sclerosis , Neurologic Manifestations , Paraparesis , Simplexvirus , Spinal Cord , SpineABSTRACT
We report 3 cases of recurrent acute disseminated encephalomyelitis (ADEM) known as multiphasic disseminated encephalomyelitis (MDEM). The 3 cases presented with fever, headache, neck stiffness, abdominal pain, seizure and decreased mentality as well as focal neurologic deficits, which showed relatively good steroid responsiveness. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement. The CSF study showed mild pleocytosis with negative oligoclonal band.
Subject(s)
Abdominal Pain , Brain , Encephalomyelitis , Encephalomyelitis, Acute Disseminated , Fever , Headache , Leukocytosis , Magnetic Resonance Imaging , Neck , Neurologic Manifestations , SeizuresABSTRACT
PURPOSE: This case is the first report of optic neuritis following acute disseminated encephalomyelitis in Korean literature and we report this case with a successful result of conservative treatment. METHODS: We examined a 7-year and-7-month-old female patient who visited our ophthalmology clinic complaining of a headache and visual disturbance in both eyes. At the time of visit, light perception was negative in both eyes, response to light reflex was nil in the right eye and weak in the left eye. Relative afferent papillary defect (RAPD) was noted in both eyes, and the disc swelling was found in both eyes on fundus examination. MRI brain scans revealed asymmetrical multifocal lesions involving the cortex and subcortex in the bilateral brain hemispheres, and contrast enhanced in T2-weighted images. Cerebrospinal fluid (CSF) examination showed results of 45 WBC, 10 polynuclear lymphocyte, and 88 monocyte cells/mm3. RESULTS: As patient was diagnosed with acute disseminated encephalomyelitis, she was prescribed intravenous steroid pulse therapy with methylprednisolone sodium succinate (Solu-medrol(R), Pharmacia, U.S.A), and immunoglobulin (Liv gamma(R), Green Cross, Korea). Seven days of steroid therapy was followed by tapering with oral steroid. Uncorrected vision was 0.9 in the right eye and 0.9 in the left. RAPD was resolved in both eyes. Visual evoked potentials showed both eyes being normal.