Adult onset acute disseminated encephalomyelitis: A case report

Abstract

Acute disseminated encephalomyelitis is an immune mediated demyelinating disorder of the central nervous system, it predominantly affects children in the age group between of 5-8 years. Is most widely thought to be a post-viral, post-vaccination autoimmune phenomenon. We present a case of 40 years old Pakistani male arrived to ER agitated with decrease level of consciousness and delirium, develop tonic-clonic convulsion and it was relieved by DIAZEPAM. This is the first attack to the patient with no past medical history of similar presentation. MRI showed supra and infratentorial white matter high T2/FLAIR signal abnormalities, involving supratentorial cortical and subcortical parito-occipital region, also to less extent at deep white matter predominantly right tempro-occipital region in asymmetric pattern. Involvement of juxta cortical and U fibers. MRI raised the possibility of adult onset Acute disseminated encephalomyelitis, after exclusion of other causes of juxta cortical and U fibers involvement (based on imaging analysis with consideration of clinical presentation and available lab results).

An Adult Case of Adenovirus-Associated Acute Disseminated Encephalomyelitis

“…ADEM is a rare immune mediated demyelinating disorder of the CNS that is most widely thought to be a post-infectious and post-vaccination autoimmune phenomenon [ 10 ]. The etiology of ADEM is still poorly understood, but there are two proposed mechanisms [ 11 ].…”

Acute Disseminated Encephalomyelitis After SARS-CoV-2 Vaccination

“…While acute disseminated encephalomyelitis can occur at any age, it is more common in pediatric patients ages 5–8 years and more rarely in adults ages 30–50 years, equally in men and women; the diagnosis is made usually after a viral illness or vaccination administration [ 1 , 2 ]. Many pathogens have been linked to ADEM, including viral and bacterial etiologies including Coronavirus, Coxsackievirus, Cytomegalovirus, Epstein-Barr, Herpes Simplex, and Measles [ 1 ].…”

“…Differential diagnosis includes multiple sclerosis, viral encephalopathies, progressive multifocal leukoencephalopathy, posterior reversible encephalopathy syndrome, cerebral autosomal dominant arteriopathy, toxic encephalopathies, adult-onset leukodystrophies, brain abscesses, tuberculomas, neurocysticercosis, histoplasmosis, toxoplasmosis, [ 1 , 2 ], human polyomavirus, tick-borne etiologies, immune-mediated vasculitis, and Alzheimer disease.…”

“…Multiphasic ADEM occurs 3 months after the initial event but when there is recurrence involving new CNS areas visualized on MRI [ 1 , 11 ]. A molecular mimicry hypothesis has been proposed that suggests there is an autoimmune reaction from post-infectious myelin protein auto-antibodies [ 2 , 10 , 12 , 13 ]. Alternatively, in the setting of a foreign antibody, there is increased vascular congestion and increased central nervous system vasculature permeability, which leads to the recommendation of anti-inflammatory modalities being a mainstay of treatment [ 1 , 14 ].…”

“…immunoglobulin [ 1 ]. Fifteen percent of adult patients will have a recurrence of the disease, 25% develop multiple sclerosis within 5 years of initial ADEM presentation, and most individuals do not have further disease progression past 3 months [ 2 , 15 ].…”