Acute disseminated encephalomyelitis

Balu, Rajesh; Shanbag, Preeti; More, Vaishali; Vaidya, Mamta

doi:10.1007/bf02828122

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Clinical details, magnetic resonance imaging (MRI) findings, and the results of other investigations were recorded, and children were followed up from 6 to 48 months. Although a few case reports of acute disseminated encephalomyelitis have been published, 5,6 no large case series with follow-up of children with acute disseminated encephalomyelitis has been published from India. The mean age at presentation was 6.14 6 3.17 years, 73.1% were male, and 17 children had a history of antecedent infectious illness or vaccination.…”

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confidence: 99%

“…It is likely that acute disseminated encephalomyelitis in developing countries is much more frequent than reported 4 ; a lack of access to hospitals and of neuroimaging facilities might account for this. Although a few case reports of acute disseminated encephalomyelitis have been published, 5,6 no large case series with follow-up of children with acute disseminated encephalomyelitis has been published from India. We have studied the clinical profile and neuroimaging findings of children with acute disseminated encephalomyelitis at presentation and during follow-up.…”

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Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

et al. 2006

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Acute disseminated encephalomyelitis in children is not uncommon in developing countries, yet there is little systematic documentation of its clinical profile and follow-up. We studied the clinical and neuroradiologic features of acute disseminated encephalomyelitis in 52 consecutive children. Clinical details, magnetic resonance imaging (MRI) findings, and the results of other investigations were recorded, and children were followed up from 6 to 48 months. A repeat MRI was done after 3 to 4 months, and in those with persistent lesions, another MRI was done after 6 to 7 months of discharge. The mean age at presentation was 6.14 +/- 3.17 years, 73.1% were male, and 17 children had a history of antecedent infectious illness or vaccination. Most children had a meningoencephalitic presentation, with sudden-onset motor weakness in 76.9% and seizures in 36.5%. Altered sensorium and pyramidal signs were seen in 55.8% and 80.7% of children, respectively. On MRI, scattered T(2)-weighted hyperintense lesions were seen, mainly in the subcortical white matter, especially in the parietal (53.8%) and frontal (30.17%) regions. Thalamic, basal ganglia, and callosal lesions were seen in 30.76%, 17.3%, and 13.46% of cases, respectively. Variable contrast enhancement was seen in 48% of those who had contrast MRIs. The response to methylprednisolone was good, with dramatic recovery in 26.9% and marked improvement in 51.9% at discharge. On follow-up, of 44 children, residual smaller MRI lesions were seen in 30. The MRI was repeated at 6 months in children with residual lesions, and it was found that the lesions either disappeared or were significantly reduced after 6 months in 75% of cases. Four children had relapse of acute disseminated encephalomyelitis with new lesions on MRI. All of them responded to methylprednisolone. None of the clinical or neuroradiologic factors at presentation had any significant correlation with relapse. Six months after discharge, no deficits could be found in 61.3% of cases; 15.9% and 4.5% had motor and cognitive deficits, and 9% had multiple deficits. The presentation of pediatric acute disseminated encephalomyelitis in developing countries is similar to that in developed countries. In spite of an aggressive presentation, most children respond well to corticosteroids. MRI lesions disappear or are significantly reduced at 6 months in the majority of cases.

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Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

et al. 2006

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“…ADEM is usually a monophasic disease 1,2,4,5 and the patients have no history suggestive of earlier demyelinating episode like optic neuritis. 5 Occasionally inadequately treated ADEM can be recurrent, recurrences occuring within 6 months of initial presentation. Here, the differentiating points favouring the diagnosis of relapsing remitting type of MS 6 in this patient rather than ADEM are:-(1) The clinical pattern consisting of 3 episodes of white matter lesions, VEP-demyelination of optic nerve), 4) clinical pattern of 3 episodes of worsening each lasting for > 24 hours and at 6 months and 2½ year intervals and 5) no other possible explanation for the disease.…”

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confidence: 99%

Childhood multiple sclerosis mimicking acute disseminated encephalomyelitis

2009

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Multiple sclerosis is a demyelinating disease affecting people in early to middle adulthood and is uncommon in childhood. Here we report a patient of multiple sclerosis who presented much before 10 years of age with features suggestive of acute disseminated encephalomyelitis and altered sensorium which is quite different from the features of multiple sclerosis in adults. Diagnosis in this patient was made on the basis of predominant white matter involvement with clinically remitting and relapsing course of the disease on follow up over 3 1/2 years, substantiated by finding multiple areas of demyelinating plaques in magnetic resonance imaging, while visual evoked potential and cerebrospinal fluid study supported demyelination. Hence, children with initial diagnosis of acute disseminated encephalomyelitis need long term follow up as they may develop multiple sclerosis.

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“…Depending on the pace of regression of the clinical features, treatment with oral prednisolone at a dose of 2 mg/kg/day can be started and a decreasing dose can be administrated for 4 to 6 weeks [16]. If the treatment is not adequate, plasmapheresis or intravenous immunoglobulines constitute an alternative treatment [17]. However, Cree leukoencephalopathy was the initial diagnosis in our patient and he was followed-up accordingly.…”

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confidence: 99%

A Case of Acute Disseminated Encephalomyelitis Mimicking Leukodystrophy

et al. 2010

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Summary: Acute disseminated encephalomyelitis (ADEM) is a monophasic, immune-mediated demyelinating disorder that can follow immunizations or more often infections including rubeola, rubella, varicella, herpes zoster, mumps, Mycoplasma pneumoniae, or, more commonly, other nonspecific upper respiratory tract infections. Documentation of a preceding illness is not required to make this diagnosis. This report examines the case of a 9-month-old male patient presenting with the features of an acute leukodystrophy following innoculation with the mixed vaccine Pentaxim (Sanofi Pasteur, Lyon-France) while suffering from a lower respiratory tract infection, and who was eventually diagnosed as ADEM. The case is presented as a reminder that ADEM can sometimes be linked to lower respiratory tract infection and vaccination, and that the features in such cases can be confused with leukodystrophy.

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Acute disseminated encephalomyelitis

Cited by 5 publications

References 10 publications

Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

Childhood multiple sclerosis mimicking acute disseminated encephalomyelitis

A Case of Acute Disseminated Encephalomyelitis Mimicking Leukodystrophy

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