WHEN YOUR DEFENSES ATTACK THE BRAIN: A SUCCESSFUL RECOVERY OF ACUTE DISSEMINATED ENCEPHALOMYELITIS

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke’s encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67–200).

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Large focal tumor-like demyelinating lesions of the brain: Intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients

Annals of Neurology ◽

10.1002/ana.410330105 ◽

1993 ◽

Vol 33 (1) ◽

pp. 18-27 ◽

Cited By ~ 242

Author(s):

John J. Kepes

Keyword(s):

Multiple Sclerosis ◽

Acute Disseminated Encephalomyelitis ◽

Demyelinating Lesions ◽

The Brain ◽

Focal Tumor

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ENCEPHALOPATHY AND ENCEPHALITIS DUE ACUTE SARS-COV-2 INFECTION: CASE REPORT

Health and Society ◽

10.51249/hes01.02.2021.298 ◽

2021 ◽

Keyword(s):

Nervous System ◽

Disease Process ◽

Vascular Diseases ◽

Acute Disseminated Encephalomyelitis ◽

Brain Dysfunction ◽

Brain Parenchyma ◽

Neurological Manifestations ◽

Inflammatory Processes ◽

Drug Interventions ◽

The Brain

Although Covid-19 disease is primarily considered an infection of the respiratory tract, it is currently known that damage and adverse reactions in the course of and after this disease affect several other bodily systems, however these issues are not yet fully understood, especially in tangent its neurological manifestations.3,4 In this sense, this report aims to add the list of many cases that are being reported/described in the literature which warn about the direct effects of the virus on the nervous system, to a disease for -infectious or post-infectious immune-mediated to COVID-19, such as acute disseminated encephalomyelitis, muscular diseases of the peripheral nervous system (Guillain-Barré syndrome), cerebrovascular and vascular diseases (CVA), and acute inflammatory processes such as that of the brain parenchyma in this case of Viral Encephalitis. Encephalitis is a diffuse or focal inflammatory process of the brain parenchyma associated with brain dysfunction, which can be divided into two main categories: alluding to systemic infections or vaccination and alluding to the entry of the pathogen into the CNS. Thus, based on the premise that several neurological manifestations are related to SARS-CoV-2 infection, a better understanding of the immune response to this infection can help not only for prevention but also can provide a valuable contribution to knowledge of the health-disease process, next human approaches, therapeutic and drug interventions

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A Case of Acute Encephalopathy Due to Autoimmune Overload

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.05.06.07 ◽

2020 ◽

Vol 5 (6) ◽

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Pediatric Population ◽

Autoimmune Disorder ◽

Acute Disseminated Encephalomyelitis ◽

Acute Encephalopathy ◽

Demyelinating Disorder ◽

Demyelinating Disorders ◽

Brain And Spinal Cord ◽

The Brain

Acute disseminated encephalomyelitis, also known as postinfectious encephalomyelitis, is considered an autoimmune disorder that causes inflammation of the brain and spinal cord. It was seen mainly in pediatric population possibly due to vaccination but there have been cases identified in adult [1-9]. Acute disseminated encephalomyelitis can be challenging to diagnose owing to fact that there have been many overlapping symptoms among other demyelinating disorder such multiple sclerosis and Neuromyelitis Optica. In this case report, we will discuss a case about a patient that presented due to acute encephalopathy and was noted to have an atypical MRI of the brain that was not consistent with results of the lumbar puncture [10-12]. Knowledge gained from this case will help bring awareness to the diagnose of acute disseminated encephalomyelitis and how imaging in context with the clinical picture can help us differentiate between the various demyelinating disorders; thereby, giving a better understanding of managing these patients as management can affect prognosis and outcomes.

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Transcranial Direct-Current Stimulation and Behavioral Training, a Promising Tool for a Tailor-Made Post-stroke Aphasia Rehabilitation: A Review

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.742136 ◽

2021 ◽

Vol 15 ◽

Author(s):

Marina Zettin ◽

Caterina Bondesan ◽

Giulia Nada ◽

Matteo Varini ◽

Danilo Dimitri

Keyword(s):

Language Processing ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Language Disorder ◽

Action Observation ◽

Direct Current Stimulation ◽

Post Stroke ◽

Successful Recovery ◽

The Brain

Aphasia is an acquired language disorder resulting from damage to portions of the brain which are responsible for language comprehension and formulation. This disorder can involve different levels of language processing with impairments in both oral and written comprehension and production. Over the last years, different rehabilitation and therapeutic interventions have been developed, especially non-invasive brain stimulation (NIBS) techniques. One of the most used NIBS techniques in aphasia rehabilitation is the Transcranial Direct-Current Stimulation (tDCS). It has been proven to be effective in promoting a successful recovery both in the short and the long term after a brain injury. The main strength of tDCS is its feasibility associated with relatively minor side effects, if safely and properly administered. TDCS requires two electrodes, an anode and a cathode, which are generally placed on the scalp. The electrode montage can be either unipolar or bipolar. The main aim of this review is to give an overview of the state of the art of tDCS for the treatment of aphasia. The studies described included patients with different types of language impairments, especially with non-fluent aphasia and in several cases anomia. The effects of tDCS are variable and depend on several factors, such as electrode size and montage, duration of the stimulation, current density and characteristics of the brain tissue underneath the electrodes. Generally, tDCS has led to promising results in rehabilitating patients with acquired aphasia, especially if combined with different language and communication therapies. The selection of the appropriate approach depends on the patients treated and their impaired language function. When used in combination with treatments such as Speech and Language Therapy, Constraint Induced Aphasia Therapy or Intensive Action Treatment, tDCS has generally promoted a better recovery of the impaired functions. In addition to these rehabilitation protocols, Action Observation Therapy, such as IMITAF, appeared to contribute to the reduction of post-stroke anomia. The potential of combining such techniques with tDCS would would therefore be a possibility for further improvement, also providing the clinician with a new action and intervention tool. The association of a tDCS protocol with a dedicated rehabilitation training would favor a generalized long-term improvement of the different components of language.

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Acute Disseminated Encephalomyelitis

10.1093/med/9780199937837.003.0089 ◽

2017 ◽

Author(s):

Benjamin M. Greenberg ◽

Allen Desena

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Supportive Care ◽

Acute Disseminated Encephalomyelitis ◽

Autoimmune Response ◽

Inflammatory Disorder ◽

The Central Nervous System ◽

The Brain

Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory disorder of the central nervous system (CNS) that can be fatal or lead to long-term disability. Various triggers have been identified in children and adults, which presumably cause an autoimmune response targeting myelin. The resulting inflammation causes demyelination and edema of the brain, spinal cord, and optic nerves. Depending on which portion of the CNS is affected, patients will experience a variety of symptoms including weakness, numbness, ataxia, encephalopathy, and seizures. Treatment is currently focused on reducing the amount of inflammation and supportive care.

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Severe acute disseminated encephalomyelitis complicating measles infection

BMJ Case Reports ◽

10.1136/bcr-2020-237346 ◽

2020 ◽

Vol 13 (11) ◽

pp. e237346

Author(s):

Hamish Duncan Morrison ◽

Clemency Clarke ◽

Richard James ◽

Nicola Giffin

Keyword(s):

Measles Virus ◽

Herd Immunity ◽

Active Role ◽

Acute Disseminated Encephalomyelitis ◽

Neurological Complications ◽

The Public ◽

Fluid Analysis ◽

Progressive Encephalopathy ◽

Brain And Spinal Cord ◽

The Brain

A 36-year-old man presented with an acute progressive encephalopathy, followed by tetraparesis and was diagnosed with acute disseminated encephalomyelitis (ADEM) complicating infection with measles virus. Despite demonstrating a typical rash and other early symptoms of measles infection, there was uncertainty around the initial diagnosis. Cerebrospinal fluid analysis and MRI of the brain and spinal cord were consistent with severe ADEM. He required treatment on intensive care but responded favourably to immunosuppressive therapy.This case highlights the importance of recognising acute measles infection, familiarity with the neurological complications and the potential for good outcome. Healthcare professionals must continue to play an active role in educating the public on the importance of maintaining herd immunity through universal immunisation.

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Acute disseminated encephalomyelitis (ADEM) associated with COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-239597 ◽

2020 ◽

Vol 13 (12) ◽

pp. e239597

Author(s):

Lawrence Langley ◽

Claudia Zeicu ◽

Louise Whitton ◽

Mathilde Pauls

Keyword(s):

Cerebrospinal Fluid ◽

Critical Care ◽

Respiratory Failure ◽

Brain Mri ◽

Acute Disseminated Encephalomyelitis ◽

Neurological Deficits ◽

Oligoclonal Bands ◽

High Dose ◽

The Brain

A 53-year-old man admitted to the critical care secondary to respiratory failure due to COVID-19 developed agitation and global hypotonia. Brain MRI revealed bilateral hyperintense lesions throughout the brain and cerebrospinal fluid identified oligoclonal bands. Intravenous high-dose glucocorticoids were administered followed by an oral tapering dose and the patient clinically improved. Acute disseminated encephalomyelitis should be considered in patients with COVID-19 who present with altered mentation and polyfocal neurological deficits.

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STUDIES ON ACUTE DISSEMINATED ENCEPHALOMYELITIS PRODUCED EXPERIMENTALLY IN RHESUS MONKEYS. III

Journal of Experimental Medicine ◽

10.1084/jem.88.4.417 ◽

1948 ◽

Vol 88 (4) ◽

pp. 417-426 ◽

Cited By ~ 61

Author(s):

Elvin A. Kabat ◽

Abner Wolf ◽

Ada E. Bezer

Keyword(s):

Spinal Cord ◽

Lymph Node ◽

Brain Tissue ◽

Rhesus Monkeys ◽

Acute Disseminated Encephalomyelitis ◽

Fish Brain ◽

Chicken Brain ◽

The Brain

The factor in brain tissue which induces acute disseminated encephalomyelitis, when injected into rhesus monkeys as an emulsion with adjuvants, has been found in human, monkey, rabbit, and chicken brain but is absent from frog and fish brain. It is unaffected by fixation of the brain in formalin, by boiling, and by treatment with ultrasound. It is present in the spinal cord of 3 day old rabbits but does not appear in the rabbit cerebrum until about the 12th day of life; in this respect it parallels the laying down of myelin. Attempts to produce the encephalomyelitis passively with large quantities of serum or of cell exudates, and suspensions of cells from spleen and lymph node from monkeys with encephalomyelitis, were unsuccessful.

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