Acute Disseminated Encephalomyelitis

Menge, Til; Hemmer, Bernhard; Nessler, Stefan; Wiendl, Heinz; Neuhaus, Oliver; Hartung, Hans Peter; Kieseier, Bernd C.; Stüve, Olaf

doi:10.1001/archneur.62.11.1673

Cited by 337 publications

(326 citation statements)

References 57 publications

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“…While the presence of various neurological manifestations, including neurogenic bladder, nystagmus, truncal ataxia and epilepsy, suggested multifocal lesions of the brain and spinal cord; taken together with antecedent infection, the clinical features in this patient, showing marked response to steroid therapy, were compatible with those of ADEM [1,6]. Although autoimmune inflammatory disorders, metabolic encephalopathy, Hashimoto's encephalopathy and brain tumors could show medial temporal lesions and ADEM-like features [8][9][10], he had no evidence of having such diseases.…”

Section: Discussionmentioning

confidence: 54%

“…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.…”

Section: Discussionmentioning

confidence: 61%

“…Magnetic resonance images (MRI) findings in ADEM have been reported in several studies; typical ADEM lesions are multifocal white matter lesions in the cerebrum [1,2], and cerebral cortical involvement has also been reported [1,[3][4][5][6]. In this case report, we describe an ADEM patient with medial temporal cortical lesions mimicking acute limbic encephalitis on MRI.…”

Section: Introductionmentioning

confidence: 75%

“…Concerning the limbic lesions, only one case of acute hemorrhagic leukoencephalitis, a more severe form of ADEM, has been reported to have features mimicking herpetic encephalitis [12]. Although multifocal white matter lesions are found in ADEM patients, several ADEM patients have been reported with cerebral cortical lesions [1,[3][4][5][6], suggesting that medial temporal lobes could be affected in patients with ADEM.…”

Section: Discussionmentioning

confidence: 99%

“…Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory disorder characterized clinically by antecedent viral infection or vaccination and sudden or acute onset disseminated encephalomyelitis, and pathologically by numerous perivascular foci of demyelination throughout the cerebrum, brainstem, cerebellum and spinal cord [1].…”

Section: Introductionmentioning

confidence: 99%

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Acute disseminated encephalomyelitis with medial temporal lesions mimicking acute limbic encephalitis

Sakai

Yoshita

Samuraki

et al. 2011

Clinical Neurology and Neurosurgery

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Acute disseminated encephalomyelitis with medial temporal lesions mimicking acute limbic encephalitis

Sakai

Yoshita

Samuraki

et al. 2011

Clinical Neurology and Neurosurgery

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Acute Fulminant Demyelinating Disease

Seze¹,

Debouverie²,

Zephir³

et al. 2007

Arch Neurol

136

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Background: Acute demyelinating encephalomyelitis (ADEM) is characterized by a severe inflammatory attack, frequently secondary to infectious events or vaccinations. To date, no clear criteria exist for ADEM, and the risk of subsequent evolution to multiple sclerosis (MS) remains unknown.Objective: To evaluate the risk of evolution to MS after a first episode of ADEM.Design: Observational, retrospective case study.Setting: Thirteen French MS centers. Patients:We retrospectively studied 60 patients with ADEM who were older than 15 years with no history suggestive of an inflammatory event who presented to MS centers from January 1, 1995, through December 31, 2005. We excluded 6 patients with multiphasic ADEM because this is a rare condition and somewhat difficult to classify. After a mean follow-up of 3.1 years (range, 1-10 years), the remaining 54 patients were then classified into 2 groups: monophasic ADEM (ADEM group) (n=35) and clinically definite MS (MS group) (n = 19). Main Outcome Measures: Clinical, laboratory, mag-netic resonance imaging, and follow-up data were evaluated for each group. Results: Patients in the ADEM group more frequently had atypical symptoms of MS (26 of 35 [74%]) than patients with MS (8 of 19 [42%]) (P=.02). Oligoclonal bands were more frequently observed in the MS group (16 of 19 [84%]) than in the ADEM group (7 of 35 [20%]) (P Ͻ.001). Patients in the ADEM group more frequently had gray matter involvement (21 of 35 [60%]) than those in the MS group (2 of 19 [11%]) (P Ͻ .001). On the basis of these results, we consider that the presence of any 2 of the following 3 criteria could be used to differentiate patients with ADEM from those with MS in our cohort: atypical clinical symptoms for MS, absence of oligoclonal bands, and gray matter involvement. On this basis, 29 of the 35 patients in the ADEM group (83%) and 18 of the 19 patients in the MS group (95%) were classified in the appropriate category. Conclusions:Our study found some differences concerning the risk of evolution to clinically definite MS after a first demyelinating episode suggestive of ADEM. These findings led us to propose criteria that should now be tested in a larger, prospective cohort study.

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Vaccines and the Risk of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases

et al. 2014

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IMPORTANCE Because vaccinations are common, even a small increased risk of multiple sclerosis (MS) or other acquired central nervous system demyelinating syndromes (CNS ADS) could have a significant effect on public health. OBJECTIVE To determine whether vaccines, particularly those for hepatitis B (HepB) and human papillomavirus (HPV), increase the risk of MS or other CNS ADS. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted using data obtained from the complete electronic health records of Kaiser Permanente Southern California (KPSC) members. Cases were identified through the KPSC CNS ADS cohort between 2008 and 2011, which included extensive review of medical records by an MS specialist. Five controls per case were matched on age, sex, and zip code. EXPOSURES Vaccination of any type (particularly HepB and HPV) identified through the electronic vaccination records system. MAIN OUTCOMES AND MEASURES All forms of CNS ADS were analyzed using conditional logistic regression adjusted for race/ethnicity, health care utilization, comorbid diseases, and infectious illnesses before symptom onset. RESULTS We identified 780 incident cases of CNS ADS and 3885 controls; 92 cases and 459 controls were females aged 9 to 26 years, which is the indicated age range for HPV vaccination. There were no associations between HepB vaccination (odds ratio [OR], 1.12; 95% CI, 0.72-1.73), HPV vaccination (OR, 1.05; 95% CI, 0.62-1.78), or any vaccination (OR, 1.03; 95% CI, 0.86-1.22) and the risk of CNS ADS up to 3 years later. Vaccination of any type was associated with an increased risk of CNS ADS onset within the first 30 days after vaccination only in younger (<50 years) individuals (OR, 2.32; 95% CI, 1.18-4.57). CONCLUSIONS AND RELEVANCE We found no longer-term association of vaccines with MS or any other CNS ADS, which argues against a causal association. The short-term increase in risk suggests that vaccines may accelerate the transition from subclinical to overt autoimmunity in patients with existing disease. Our findings support clinical anecdotes of CNS ADS symptom onset shortly after vaccination but do not suggest a need for a change in vaccine policy.

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Acute Disseminated Encephalomyelitis

Cited by 337 publications

References 57 publications

Acute disseminated encephalomyelitis with medial temporal lesions mimicking acute limbic encephalitis

Acute disseminated encephalomyelitis with medial temporal lesions mimicking acute limbic encephalitis

Acute Fulminant Demyelinating Disease

Vaccines and the Risk of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases

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