scholarly journals A case of acute disseminated encephalomyelitis (ADEM)

2019 ◽  
Vol 7 (3) ◽  
pp. 100-103
Author(s):  
Saba Nemati-Ahmadabad ◽  
Sheida Shaafi ◽  
Seyedpouya Paknezhad ◽  
Mahboob Pouraghaei
Keyword(s):  
Emergency Department ◽  
Laboratory Tests ◽  
Demyelinating Disease ◽  
Past History ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Deficits ◽  
High Dose ◽  
Motor Weakness ◽  
General Weakness ◽  
Specific Symptoms

Introduction: Acute disseminated encephalomyelitis (ADEM) is an uncommon monophasic idiopathic inflammatory demyelinating disease. ADEM typically presents with non-specific symptoms including nausea, vomiting, fever, and headache. This then progresses to neurological deficits such as motor weakness, altered sensorium, and often significant morbidity or mortality. Typically, the infectious insult is thought to be in transient viral infection or vaccination. Case Report: We describe a case of ADEM in a 15-year-old girl that came to emergency department with dizziness and general weakness; she was unable to speak, and lethargic, with no positive past history. Her laboratory tests and spiral brain computed tomography (CT) scan were normal. She was admitted to neurology ward, and threated with high-dose corticosteroids. Our patient responded well to corticosteroids. Conclusion: In patients with neurologic deficits in emergency department, the physician must think about ADEM although it is rare.

Acute Disseminated Encephalomyelitis

2013 ◽  
Author(s):  
Aaron E. Miller ◽  
Teresa M. DeAngelis
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Acute Disseminated Encephalomyelitis ◽  
Initial Presentation ◽  
Neurological Deficits ◽  
First Episode ◽  
Therapeutic Considerations

Acute disseminated encephalomyelitis (ADEM), a fulminant episode of demyelinating disease, which can be confused with a first episode of multiple sclerosis (MS), can present with transiently severe neurological deficits requiring hospitalization and support care. In this chapter, we review the important differential diagnostic and therapeutic considerations and how best to differentiate ADEM from an initial presentation of MS.

scholarly journals Acute disseminated encephalomyelitis (ADEM) associated with COVID-19

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.

Fulminant Acute Disseminated Encephalomyelitis: A Remarkable Outcome with Cyclophosphamide

2020 ◽  
Author(s):  
Hadas Meirson ◽  
Shelly I. Shiran ◽  
Michal Raz ◽  
Jonathan Roth ◽  
Aviva Fattal-Valevski
Keyword(s):  
Central Nervous System ◽  
Acute Treatment ◽  
Demyelinating Disease ◽  
Pediatric Population ◽  
Acute Disseminated Encephalomyelitis ◽  
High Dose ◽  
Cyclophosphamide Treatment ◽  
The Central Nervous System ◽  
Intravenous Glucocorticoids ◽  
Cyclophosphamide Administration

AbstractAcute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system which occurs predominantly in the pediatric population. Acute treatment is high-dose intravenous glucocorticoids. Alternative treatment is usually intravenous immune globulin and/or plasma exchange. Fulminant ADEM is rare in children. Only a few cases of cyclophosphamide use in refractory ADEM have been reported. Here, we report a case of a 12-year-old girl with fulminant ADEM who was comatose and improved dramatically after cyclophosphamide administration. Cyclophosphamide treatment should be considered as a therapy in children with fulminant ADEM nonresponsive to standard therapies.

scholarly journals Role of Plasma Exchange in a Steroid- and IVIG-Refractory Patient with Acute Disseminated Encephalomyelitis: A Case Report

2020 ◽  
Vol 47 (5) ◽  
pp. 420-423 ◽  
Author(s):  
Parmatma Prasad Tripathi ◽  
Rekha Hans ◽  
Ratti Ram Sharma ◽  
Divjot Singh Lamba ◽  
Preeti Paul ◽  
...  
Keyword(s):  
Case Report ◽  
Plasma Exchange ◽  
Intravenous Immunoglobulin ◽  
Steroid Therapy ◽  
Neurological Deficit ◽  
Demyelinating Disease ◽  
Acute Disseminated Encephalomyelitis ◽  
Complete Loss ◽  
High Dose

Background: Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease usually affecting children and is treated with high-dose steroid therapy. Case Report: An 8-year boy presented with limbs weakness and complete loss of vision and was resistant to steroid therapy. He was further treated with plasma exchange and showed full recovery from the neurological deficit. Conclusion: Therapeutic plasma exchange appears to be effective in ADEM patients in reversing the neuropathological process especially refractory to steroids and intravenous immunoglobulin.

scholarly journals Acute Disseminated Encephalomyelitis following Vaccination against Hepatitis B in a Child: A Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Jun-liang Yuan ◽  
Shuang-kun Wang ◽  
Xiao-juan Guo ◽  
Wen-li Hu
Keyword(s):  
Hepatitis B ◽  
Marked Improvement ◽  
Demyelinating Disease ◽  
Clinical Symptoms ◽  
Acute Disseminated Encephalomyelitis ◽  
Hepatitis B Vaccination ◽  
High Dose ◽  
The Central Nervous System ◽  
Alteration Of Consciousness ◽  
Brain And Spinal Cord

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system, which has been associated with several vaccines such as rabies, diphtheria-tetanus-polio, smallpox, measles, mumps, rubella, Japanese B encephalitis, pertussis, influenza, and the Hog vaccine. Here, we presented a case of 12-year-old child who suffered from ADEM three weeks after hepatitis B vaccination. He was admitted to our hospital with symptoms of weakness of limbs, high fever, and alteration of consciousness. Some abnormalities were also found in CSF. Treatment with high-dose corticosteroids and intravenous immunoglobulin had significant effect, with marked improvement of the clinical symptoms and the results of CSF. The findings of MRI also detected some abnormal lesions located in both brain and spinal cord. The clinical features, the findings of CSF and MRI, and therapeutic effect may contribute to such diagnosis of ADEM.

scholarly journals Pseudotumoral Demyelinating Lesions: A Presentation of Acute Disseminated Encephalomyelitis

2021 ◽  
pp. 289-296
Author(s):  
Rachid Belfkih ◽  
Omar Ghomari Khayat ◽  
Hind H’daidane ◽  
Fatima Zahra El Amrani
Keyword(s):  
Multiple Sclerosis ◽  
Brain Mri ◽  
Brain Biopsy ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Deficits ◽  
High Dose ◽  
Good Recovery ◽  
Disease Diagnostics ◽  
Demyelinating Lesions ◽  
Demyelinating Disorders

Pseudotumoral forms of demyelination are related to central nervous system demyelinating disorders, usually considered to be an atypical presentation of multiple sclerosis including its different varieties such as Balo’s, Schilder’s, and Marburg diseases. These lesions could also be seen in myelin oligodendrocyte glycoprotein antibody-associated demyelination, acute disseminated encephalomyelitis (ADEM), and neuromyelitis optica spectrum disorder. The pseudotumoral aspect may be mistakenly considered as an abscess or a cancerous tumor, in which case, patients could endure unnecessary possibly harmful brain biopsy and have a delay in their disease diagnostics and management. Once latter differential diagnosis is discarded, pseudotumoral demyelination prompts uncertainties concerning the nature of the underlying demyelinating condition as prognosis and management differ from multiple sclerosis to other syndromes, especially whether a chronic treatment is needed or not. In this case report, we present a 35-year-old male patient hospitalized in the department of neurology for a rapidly progressive onset of encephalopathy and polyfocal neurological deficits, with pseudotumoral lesions shown on brain MRI. On further investigations, ADEM was the more likely diagnosis that could fit the patient’s clinical and radiological presentation. Thence, he was put on high dose of intravenous corticosteroids, with a followed good recovery within the first week of the treatment.

scholarly journals A Case of Acute Disseminated Encephalomyelitis in a Middle-Aged Adult

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Nicole Mahdi ◽  
Peter A. Abdelmalik ◽  
Mark Curtis ◽  
Barak Bar
Keyword(s):  
White Matter ◽  
Brain Mri ◽  
Brain Biopsy ◽  
Acute Disseminated Encephalomyelitis ◽  
Steroid Treatment ◽  
Neurological Deficits ◽  
High Dose ◽  
Middle Aged ◽  
Neurological Exam ◽  
Middle Aged Adult

Objectives. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that is often preceded by infection or recent vaccination. Encephalopathy and focal neurological deficits are usually manifest several weeks after a prodromal illness with rapidly progressive neurologic decline. ADEM is most commonly seen in children and young adults, in which prognosis is favorable, but very few cases have been reported of older adults with ADEM and thus their clinical course is unknown.Methods. Here we present a case of ADEM in a middle-aged adult that recovered well after treatment.Results. A 62-year-old man presented with encephalopathy and rapid neurological decline following a gastrointestinal illness. A brain MRI revealed extensive supratentorial white matter hyperintensities consistent with ADEM and thus he was started on high dose intravenous methylprednisolone. He underwent a brain biopsy showing widespread white matter inflammation secondary to demyelination. At discharge, his neurological exam had significantly improved with continued steroid treatment and four months later, he was able to perform his ADLs.Conclusions. This case of ADEM in a middle-aged adult represents an excellent response to high dose steroid treatment with a remarkable neurological recovery. Thus it behooves one to treat suspected cases of ADEM in an adult patient aggressively, as outcome can be favorable.

Gene Therapy Approaches in an Autoimmune Demyelinating Disease: Multiple Sclerosis

2020 ◽  
Vol 19 (6) ◽  
pp. 376-385
Author(s):  
Md. A. Islam ◽  
Shoumik Kundu ◽  
Rosline Hassan
Keyword(s):  
Multiple Sclerosis ◽  
Gene Therapy ◽  
Disease Progression ◽  
Demyelinating Disease ◽  
Human Subjects ◽  
Mice Model ◽  
Focal Lesions ◽  
Protective Function ◽  
Monocytes And Macrophages ◽  
Specific Symptoms

Multiple Sclerosis (MS) is the most common autoimmune demyelinating disease of the Central Nervous System (CNS). It is a multifactorial disease which develops in an immune-mediated way under the influences of both genetic and environmental factors. Demyelination is observed in the brain and spinal cord leading to neuro-axonal damage in patients with MS. Due to the infiltration of different immune cells such as T-cells, B-cells, monocytes and macrophages, focal lesions are observed in MS. Currently available medications treating MS are mainly based on two strategies; i) to ease specific symptoms or ii) to reduce disease progression. However, these medications tend to induce different adverse effects with limited therapeutic efficacy due to the protective function of the blood-brain barrier. Therefore, researchers have been working for the last four decades to discover better solutions by introducing gene therapy approaches in treating MS generally by following three strategies, i) prevention of specific symptoms, ii) halt or reverse disease progression and iii) heal CNS damage by promoting remyelination and axonal repair. In last two decades, there have been some remarkable successes of gene therapy approaches on the experimental mice model of MS - experimental autoimmune encephalomyelitis (EAE) which suggests that it is not far that the gene therapy approaches would start in human subjects ensuring the highest levels of safety and efficacy. In this review, we summarised the gene therapy approaches attempted in different animal models towards treating MS.

Acute Colonic Diverticulitis: Diagnostic Evidence, Demographic and Clinical Features in ree Practice Settings

2014 ◽  
Vol 23 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Rajan Iyer ◽  
George F. Longstreth ◽  
Li-Hao Chu ◽  
Wansu Chen ◽  
Linnette Yen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Clinical Features ◽  
Clinical Characteristics ◽  
Past History ◽  
Colonic Diverticulitis ◽  
Co Morbidity ◽  
Objective Evidence ◽  
Multiple Variables ◽  
Acute Colonic Diverticulitis

Background & Aims: Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features.Methods: In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features.Results: Inpatients were older and more often underweight/normal weight and lacked a diverticulitis past history and had more comorbidities than other patients. Outpatients were most often Hispanic/Latino. The classical triad (abdominal pain, fever, leukocytosis) occurred in 78 (38.6%) inpatients, 29 (5.2%) outpatients and 34 (10.7%) emergency department cases. Computed tomography was performed on 196 (94.4%) inpatients, 110 (9.2%) outpatients and 296 (87.6%) emergency department cases and was diagnostic in 153 (78.6%) inpatients, 62 (56.4%) outpatients and 243 (82.1%) emergency department cases. Multiple variables affected presenting features. Notably, female sex had lower odds for the presence of the triad features (odds ratio [95% CI], 0.65 [0.45-0.94], P<0.05) and increased odds of vomiting (1.78 [1.26-2.53], P<0.01). Patients in age group 56 to 65 and 66 or older had decreased odds of fever (0.67 [0.46-0.98], P<0.05) and 0.46 [0.26-0.81], P<0.01), respectively, while ≥1 co-morbidity increased the odds of observing the triad (1.88 [1.26-2.81], P<0.01).Conclusion: There was little objective evidence for physician-diagnosed diverticulitis in most outpatients. Demographic and clinical characteristics vary among settings and independently affect presenting features.Abbreviations: AD: acute colonic diverticulitis; BMI: body mass index; CT: computed tomography; ED: emergency department; IBS: irritable bowel syndrome; ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification; IP: inpatient; KPSC: Kaiser Permanente Southern California; OP: outpatient.

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