• Title, Summary, Keyword: ADEM

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Acute disseminated encephalomyelitis in children: differential diagnosis from multiple sclerosis on the basis of clinical course

  • Lee, Yun-Jin
    • Korean Journal of Pediatrics
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    • v.54 no.6
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    • pp.234-240
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    • 2011
  • Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system (CNS) that typically presents as a monophasic disorder associated with multifocal neurologic symptoms and encephalopathy. ADEM is considered an autoimmune disorder that is triggered by an environmental stimulus in genetically susceptible individuals. The diagnosis of ADEM is based on clinical and radiological features. Most children with ADEM initially present with fever, meningeal signs, and acute encephalopathy. The level of consciousness ranges from lethargy to frank coma. Deep and subcortical white-matter lesions and gray-matter lesions such as thalami and basal ganglia on magnetic resonance imaging (MRI) are associated with ADEM. In a child who presents with signs of encephalitis, bacterial and viral meningitis or encephalitis must be ruled out. Sequential MRI is required to confirm the diagnosis of ADEM, as relapses with the appearance of new lesions on MRI may suggest either multiphasic ADEM or multiple sclerosis (MS). Pediatric MS, defined as onset of MS before the age of 16, is being increasingly recognized. MS is characterized by recurrent episodes of demyelination in the CNS separated in space and time. The McDonald criteria for diagnosis of MS include evidence from MRI and allow the clinician to make a diagnosis of clinically definite MS on the basis of the interval preceding the development of new white matter lesions, even in the absence of new clinical findings. The most important alternative diagnosis to MS is ADEM. At the initial presentation, the 2 disorders cannot be distinguished with certainty. Therefore, prolonged follow-up is needed to establish a diagnosis.

Effect of an Ankle Strengthening Exercise that Uses PNF on the Balance and Walking Ability of Patients with Acute Disseminated Encephalomyelitis -A Single Case Study- (PNF를 이용한 발목 강화 운동이 급성파종성 뇌척수염 환자의 균형 및 보행 향상에 미치는 영향 -단일사례연구-)

  • Jung, Du-Kyo
    • PNF and Movement
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    • v.15 no.1
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    • pp.85-96
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    • 2017
  • Purpose: Peripheral neuropathy accompanied by sensory disturbance, such as limb paralysis and hemiplegia, is mainly caused by acute disseminated encephalomyelitis (ADEM). This case study aimed to determine the effect of ankle strengthening exercises that use proprioceptive neuromuscular facilitation (PNF) on the gait, balance, ankle-control ability, and sit-to-stand ability on a patient with ADEM. Methods: A 10-year-old male with quadriplegia and ankle-control impairment participated in this 4-week training intervention. The patient, diagnosed with ADEM, was treated with ankle strengthening exercises that used PNF. Results: The patient demonstrated improvements in balance, ankle-control ability, sit-to-stand ability, and gait performance. Outcome measures (manual muscle test, modified Ashworth scale, sensory assessment, coordination assessment, Berg balance scale, 5 time sit-to-stand test, and 10 m walk test) were taken before and after the training program. Conclusion: The results of this case suggest that an ankle strengthening exercise that uses PNF can improve the gait, balance, ankle-control ability, and sit-to-stand ability in patients with ADEM. In ADEM, the initial treatment is important, and the use of ankle strengthening exercises with PNF could lead to meaningful results. However, there is limited research due to an insufficient number of cases. In the future, more patients will need to be studied.

Clinical Observation on 2 Cases of Acute Disseminated Encephalomyelitis(ADEM) (급성 파종성 뇌척수염 환자의 치험 2례)

  • Koo, Beom-Mo;Lee, Kyung-Yun;Yang, Dong-Ho;Kim, Sung-Keun;Lim, Chang-Sun;Park, Young-Chul;Yi, Joo-Il;Kim, Joo-Young
    • Journal of Acupuncture Research
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    • v.25 no.3
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    • pp.189-196
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    • 2008
  • Objectives : The purpose of this case is to report the improvement of the patients with Acute Disseminated Encephalomyelitis(ADEM) after acupuncture, moxibustion, and herbal medicine. Methods : We treated the patients with acupuncture, moxibustion and herbal medication. Results : We treated two cases of Acute Disseminated Encephalomyelitis(ADEM). These two patients improved significantly through treatment, acupuncture, moxibustion, herbal medicine, and western medicine. Conclusions : In Acute Disseminated Encephalomyelitis (ADEM), the initial diagnosis is important, and through a collaboration of Western and Korean medicine, we were able to achieve meaningful treatment results.

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Acute Disseminated Encephalomyelitis(ADEM) Presenting as Multiple Cystic Lesions - A Case Report - (다발성 낭종성 병변을 보인 급성 파종성 뇌척수염 - 증례보고 -)

  • Kim, Dae Won;Kim, Tae Young;Kim, Jong Moon;Yun, Ki Jung
    • Journal of Korean Neurosurgical Society
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    • v.30 no.5
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    • pp.622-626
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    • 2001
  • Acute disseminated encephalomyelitis(ADEM) is an uncommon immune-mediated inflammatory demyelinating disorder that typically affects the white matter of the central nervous system. Radiologic findings of acute disseminated encephalomyelitis are not pathognomomic. The differential diagnosis is always difficult. Occasionally, the clinical features, radiological and histopathological findings of patients with acute disseminated encephalomyelitis mimic the brain tumor or other space occupying lesions. The authors report a 6-year-old girl who presented with right hemiparesis two days after nausea and vomiting. Brain MRI of the patient revealed non-enhanced multiple cystic lesions in subcortical white matter of both cerebral hemisphere with prominent edema. One of the cystic lesions was resected to differentiate with metastatic tumor or inflammatory disease such as abscess and confirmed as the acute disseminated encephalomyelitis via various immunohistochemical stains. Pertinent literature is reviewed with discussion on this uncommon ADEM associated with multiple cystic lesions.

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Acute disseminated encephalomyelitis caused by Epstein-Barr virus infection in an immunocompetent adult woman

  • Oh, Hyunjoo;Yoo, Jeong Rae;Heo, SangTaek;Oh, Jung-Hwan;Lee, Ho Kyu
    • The Journal of Medicine and Life Science
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    • v.16 no.1
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    • pp.17-22
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    • 2019
  • Epstein-Barr virus(EBV) infection is common and usually asymptomatic in young infants and children. However, EBV infections in transplant recipients and other immunosuppressed patients can be fatal. EBV-related neurological complications in immunocompetent adults are extremely rare and self-limited. Acute disseminated encephalomyelitis(ADEM) may also follow EBV infection; ADEM is characterized by abrupt onset and rapid progression. We report an immunocompetent adult patient who developed diffuse meningoencephalitis with ADEM-like features caused by EBV infection. A 35-year-old Vietnamese woman was admitted presenting with urinary retention, altered mental status, and paraplegia. PCR of the patient's cerebrospinal fluid showed positive results for EBV. Brain and spine magnetic resonance imaging showed ADEM-like features. She was treated with acyclovir, steroid, and immunoglobulins. We report the case of an immunocompetent adult Vietnamese woman who presented with rapidly progressive diffuse meningoencephalitis associated with EBV infection and was treated with antivirals, corticosteroids, and immunoglobulins.

Acute Disseminated Encephalomyelitis Presenting as Rhombencephalitis: An Atypical Case Presentation

  • Hwang, Joonseok;Lee, A Leum;Chang, Kee Hyun;Hong, Hyun Sook
    • Investigative Magnetic Resonance Imaging
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    • v.19 no.3
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    • pp.186-190
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    • 2015
  • Acute disseminated encephalomyelitis (ADEM) is a demyelinating and inflammatory condition of the central nervous system, occurring predominantly in white matter. ADEM involving the rhombencephalon without affecting the white matter is very rare. Here, we present an unusual case of ADEM involving only the rhombencephalon in a 4-year-old Asian girl. The patient complained of pain in the right lower extremities, general weakness, ataxia, and dysarthria. The initial brain CT showed subtle ill-defined low-density lesions in the pons and medulla. On brain MRI, T2 high signal intensity (T2-HSI) lesions with mild swelling were present in the pons, both middle cerebellar peduncles, and the anterior medulla. The initial diagnosis was viral encephalitis involving the rhombencephalon. Curiously, a cerebrospinal fluid (CSF) study revealed no cellularity, and negative viral marker findings. Three weeks later, follow up brain MRI showed that the extent of the T2-HSI lesions in the brain stem had decreased. After reinvestigation, it was found that she had a prior history of upper respiratory infection. In this case, we report the very rare case of a patient showing isolated involvement of the rhombencephalon in ADEM, mimicking viral rhombencephalitis on CT and MR imaging. ADEM can involve unusual sites such as the rhombencephalon in isolation, without involvement of the white matter or deep gray matter and, therefore, should be considered even when it appears in unusual anatomical areas. Thorough history taking is important for making a correct diagnosis.

Acute combined central and peripheral nervous system demyelination: a case report

  • Roh, Young Eun;Kim, Young Mi
    • Kosin Medical Journal
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    • v.33 no.2
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    • pp.257-262
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    • 2018
  • Guillain-$Barr{\acute{e}}$ syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are demyelinating neurologic disorders with different target organs. Although they share similar pathogenetic mechanism, reports of simultaneous occurrence of the 2 disorders are rare. A 2 year 6 month old girl visited our hospital for fever, cough, and general weakness. Although the muscle power of extremities showed mild weakness and voiding difficulty, initial deep tendon reflex of both knees and ankles was normal. A nerve conduction study to evaluate the weakness revealed the absence of F waves. Cerebrospinal fluid analysis demonstrated pleocytosis with lymphocyte predominance and elevated protein levels. Magnetic resonance imaging showed abnormal T2 hyperintensity in pons, medulla and spinal cord. Serum anti-GD1b antibody was positive. Based on clinical findings, laboratory findings, nerve conduction study, and neuroimaging, the diagnosis of GBS and ADEM was made. This is the first case of GBS accompanied by ADEM in Korea.

An adverse event following 2009 H1N1 influenza vaccination: a case of acute disseminated encephalomyelitis

  • Lee, Sang-Teak;Choe, Young-June;Moon, Won-Jin;Choi, Jin-Woo;Lee, Ran
    • Korean Journal of Pediatrics
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    • v.54 no.10
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    • pp.422-424
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    • 2011
  • Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that typically follows an infection or vaccination and has a favorable long-term prognosis. We describe the first reported case of ADEM after vaccination against novel influenza A (H1N1). A previously healthy 34-month-old boy who developed ADEM presented with a seizure and left-sided weakness 5 days after vaccination against novel influenza A (H1N1). Cerebrospinal fluid examination revealed elevated cell counts. T2-weighted images and fluid-attenuated inversion recovery images revealed multiple patchy hyperintense lesions in the frontal and parietal subcortical white matter and the left thalamus. After the administration of intravenous corticosteroid, the patient's clinical symptoms improved and he recovered completely without neurologic sequelae.

Clinical characteristics and prognosis of acute disseminated encephalomyelitis based on the lesions on MRI (자기공명영상의 병변에 따른 급성 파종성 뇌척수염의 임상 양상과 예후)

  • Chung, Sunghoon;Park, Sungsin;Chung, Sajun
    • Korean Journal of Pediatrics
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    • v.50 no.9
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    • pp.891-895
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    • 2007
  • Purpose : Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system and mostly develops after viral illness or vaccinations. We investigated the clinical differences and neurologic outcomes according to the distribution of the lesions on brain MRI. Methods : The study group was composed of 21 patients from January 1995 to August 2003 in Kyunghee University hospital. We grouped the patients according to the MRI findings as follows. Group I (14 cases): Multi- or unifocal lesions only in the cerebral white matter. Group II (7 cases): lesions in the gray matter with or without white matter involvement. Results : 1. Preceding events were as follows: no defined prodrome (38.1%), upper respiratory tract infection (28.6%), nonspecific febrile illness (19.0%), gastointestinal disturbance and vaccination. 2. Presenting symptoms were as follows: seizures (76.2%), headache/vomiting (47.6%), altered consciousness (38.1%), hemiparesis, cerebellar ataxia, visual disturbance and facial nerve palsy. 3. Laboratory findings were as follows: CSF pleocytosis (76.2%), leucocytosis (38.1%) and elevated CSF protein (28.6%). 4. Fifteen patients were recovered completely without neurological sequelae. Three patients in group I and 1 patient in group II had intractable seizures. Two patients in group I and 2 patients in group II had motor disturbance. Conclusion : There were no statistically significant differences in preceding events, presenting symptoms, and neurological outcomes according to the distribution of the lesions on brain MRI. However, the ADEM have quite diverse clinical manifestations and neuroimage findings. MRI plays an important role in making diagnosis of the patients who are suspected of ADEM.

Development of An Agricultural Drought Evaluation Model for Administrative Decision Support (가뭄대책 행정지원을 위한 지역논가뭄평가모형 ADEM의 개발)

  • Jang, Min-Won;Chung, Ha-Woo;Park, Ki-Wook
    • Journal of Korean Society of Rural Planning
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    • v.9 no.2
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    • pp.29-37
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    • 2003
  • The objectives of this study are to develop an agricultural drought evaluation model based on administrative boundaries and to assist the effective drought-related decision-making of local governments. The model which was named ADEM(Administrative Drought Evaluation Model for Paddies) is designed to simulate daily water balance between available water quantities from various agricultural water facilities such as reservoirs, wells, pump stations, etc. and water requirements in paddies. And in order to numerically describe the agricultural drought severity, two indices were defined; One is ADFP(Agricultural Drought Frequency for Paddies) which is calculated with a frequency analysis of monthly water deficit, and the other is ADIP(Agricultural Drought Index for Paddies) with a scale of $-4.2{\sim}+4.2$. The developed model was applied to Yeoju district and showed good correspondence with the historical records of drought.