Acute disseminated encephalomyelitis in adults: a reappraisal of clinical, CSF, EEG, and MRI findings

Abstract

The EEG as an investigation of brain function can be crucial in establishing the organic nature of disease. MRI is important to exclude other diffuse or multifocal encephalopathies. However, in contrast to previous reports in the literature abnormal MRI should not be considered mandatory in adult ADEM. Difficulties in the diagnosis of ADEM are discussed and the importance of clinical and paraclinical findings for establishing the diagnosis is outlined.

Acute disseminated encephalomyelitis: clinical features, HLA DRB1*1501, HLA DRB1*1503, HLA DQA1*0102, HLA DQB1*0602, and HLA DPA1*0301 allelic association study

“…The CSF analysis in our series showed pleocytosis in only one patient, different from literature that usually find it, but the rarity of intrathecal band found here is in according with other studies 33,34 . Besides these findings, CSF results are not distinctive enough to allow discrimination between ADEM and MS.…”

Acute disseminated encephalomyelitis with medial temporal lesions mimicking acute limbic encephalitis

“…The diagnosis of ADEM requires the following: acute onset, symptoms and signs of disseminated multifocal central nervous system involvement and an antecedent infection or vaccination [1,6,13]; MRI findings are frequently normal even in patients with severe clinical manifestations [13]. Taken together with these findings, although the possibilities of another cause of acute limbic encephalitis are not fully excluded, our patient indicates the existence of an atypical form of ADEM with lesions confined to the limbic system on MRI.…”

“…Concerning normal CSF findings and the absence of demyelinating lesions detected on MRI, several ADEM patients that lacked pleocytosis or MRI findings have been reported [4,13]. The diagnosis of ADEM requires the following: acute onset, symptoms and signs of disseminated multifocal central nervous system involvement and an antecedent infection or vaccination [1,6,13]; MRI findings are frequently normal even in patients with severe clinical manifestations [13].…”

Acute disseminated encephalomyelitis following inactivated influenza vaccination in the Brazilian Amazon: a case report

“…Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system (3) . Its onset is acute and often rapidly progressive (4) . It is traditionally monophasic, but some patients may have recurrences.…”

“…ADEM typically presents with multifocal neurological signs, including motor, sensory, cranial nerve, and brainstem defi cits, as well as nonspecifi c symptoms such as headache, malaise, and altered mental status (i.e., encephalopathy) (4) . The diagnosis is supported by the presence of one or more supratentorial or infratentorial demyelinating lesions on brain magnetic resonance imaging (MRI) and the absence of destructive black hole lesions on T1-weighted MRI (4) . Abnormal cerebrospinal fl uid fi ndings such as mild lymphocytic pleocytosis and slightly elevated cerebrospinal fl uid (CSF) protein level are suggestive of ADEM, but not essential for diagnosis.…”