A Case of Acute Disseminated Encephalomyelitis in a Middle-Aged Adult

Abstract

Objectives. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that is often preceded by infection or recent vaccination. Encephalopathy and focal neurological deficits are usually manifest several weeks after a prodromal illness with rapidly progressive neurologic decline. ADEM is most commonly seen in children and young adults, in which prognosis is favorable, but very few cases have been reported of older adults with ADEM and thus their clinical course is unknown. Methods. Here we present a case of ADEM in a middle-aged adult that recovered well after treatment. Results. A 62-year-old man presented with encephalopathy and rapid neurological decline following a gastrointestinal illness. A brain MRI revealed extensive supratentorial white matter hyperintensities consistent with ADEM and thus he was started on high dose intravenous methylprednisolone. He underwent a brain biopsy showing widespread white matter inflammation secondary to demyelination. At discharge, his neurological exam had significantly improved with continued steroid treatment and four months later, he was able to perform his ADLs. Conclusions. This case of ADEM in a middle-aged adult represents an excellent response to high dose steroid treatment with a remarkable neurological recovery. Thus it behooves one to treat suspected cases of ADEM in an adult patient aggressively, as outcome can be favorable.

Atypical Presentation of Acute Disseminated Encephalomyelitis (ADEM) in a Middle-Aged Adult

“…It was not determined whether or not the patient had a previous episode of viral gastroenteritis. ADEM is more commonly a condition that presents in childhood, and the diagnosis in adults and the elderly remains challenging, as there are no established diagnostic criteria [1].…”

“…Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease that presents with acute inflammation and demyelination of the central nervous system (CNS) in a monophasic manner. ADEM is more commonly a disease of childhood that often follows viral infections, bacterial infections, or vaccinations [1,2]. The clinical characteristics include focal neurologic deficits, accompanied by encephalopathy, that develop one to three weeks after viral infection [1,2].…”

“…ADEM is more commonly a disease of childhood that often follows viral infections, bacterial infections, or vaccinations [1,2]. The clinical characteristics include focal neurologic deficits, accompanied by encephalopathy, that develop one to three weeks after viral infection [1,2]. ADEM can be associated with rapid neurologic decline, but spastic paresis alone is rarely seen.…”

“…ADEM is more commonly seen in children and young adults and rarely occurs in middle-aged or elderly adults. The course may be fulminant, but typically there is recovery in 50–75% of cases, with progression to multiple sclerosis (MS) in up to 20% of cases [1,2]. An atypical case of ADEM is reported that presented in a middle-aged adult.…”

Kəskin disseminəolunmuş ensefalomielit

“…Ölüm daha çox fulminant, sürətlə proqressivləşən hallarda baş verir (412%) [15,22,25]. KDEMə görə reanimasiyada müalicə alan xəstələrin 35%də evə yazıldıqda daimi əlillik qeyd edilir [21]. This study examines the new literature on acute disseminated encephalomyelitis (ADEM) or postinfectious encephalomyelitis (encephalomyelitis that develops after infection), and evidencebased information has been col lected by studying its epidemiology, etiological causes, clinical course, diagnostic criteria, and management.…”