• Title, Summary, Keyword: Acute Disseminated Encephalomyelitis

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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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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 Motor Axonal Neuropathy Combined with Acute Disseminated Encephalomyelitis (급성 파종성 뇌척수염에 동반된 급성 운동 축삭형 신경병증)

  • Yu, Seong-Yong;Lim, Eui-Seong;Shin, Byoung-Soo;Seo, Man-Wook;Kim, Young-Hyun
    • Annals of Clinical Neurophysiology
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    • v.6 no.1
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    • pp.52-56
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    • 2004
  • Acute motor axonal neuropathy (AMAN) is a subtype of Guillain-Barre syndrome and characterized by selective involvement of motor fibers. Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of central nervous system. The coincidence of central and peripheral nervous system involvement has been reported rarely. We described a 37-year-old male patient presented with fever and altered consciousness. The examination of cerebrospinal fluid and brain magnetic resonance imaging was compatible with acute disseminated encephalomyelitis. Several days after admissionb his mentality was improved but quadriparesis, multiple cranial neuropathies, and areflexia were detected. Electrophysiologic studies suggested axonal form of motor dominant polyneuropathy. We report a case of acute motor axonal neuropathy combined with ADEM. We consider that this case is an example of simultaneous immunologic process to the common pathogenic epitope of central nervous system and peripheral nervous system.

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A Case of Acute Disseminated Encephalomyelitis by Enterovirus 71 (Enterovirus 71에 의한 급성 파종성 뇌척수염 1례)

  • Hwang, Hui Sung;Cho, Sung Hee;Kim, Sun Mi;Jung, Dae Chul;Chung, Seung Yun;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.10 no.1
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    • pp.114-122
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    • 2003
  • Acute transverse myelitis is a focal inflammatory disorder of the spinal cord, resulting in motor, sensory, and autonomic dysfunction which would be the initial manifestation of acute disseminated encephalomyelitis. A 7-year-old boy developed weakness of lower extremities associated with dizziness and urinary dysfunction after upper respiratory infection. He showed gradual decreased mental status with respiratory difficulty. Spinal MRI showed diffuse spinal cord swelling from C3 to C7 levels with high signal intensity lesion on T2-weighted image, which is involved central gray matter of spinal cord from C3 to C7, proximal portion to cervicomedullary junction, and distal portion to the cornus medullaris. After the supplement of high dose intravenous methylprednisolone therapy with ventilator care, he showed gradual improvement. The brain MRI after extubation showed multifocal high signal intensity lesions in bilateral cerebral white matter on axial T2-weighted image. Immunoserologic test(neutral antibody test) for enterovirus 71 was positive. Dysfunction of the bladder lasted for 33 days. We report a case of transverse myelitis which progressed to acute disseminated encephalomyelitis by enterovirus 71 in a 7-year-old boy with related literatures.

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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.

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.

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.

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.

Atypical Manifestation of Acute Hemorrhagic Leukoencephalitis (Hurst's Disease) (비전형적인 중상으로 발현한 급성 출혈성 백질뇌염)

  • Min, Ju-Hong;Lee, Su-Ho;Cho, Joong-Yang;Park, Sung-Hye;Lee, Kwang-Woo
    • Annals of Clinical Neurophysiology
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    • v.7 no.1
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    • pp.37-42
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    • 2005
  • Acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (Hurst's disease) are rare autoimmune demyelinating disorders, which show a monophasic illness with preceding infection. We report a 42-year-old woman presented with multiphasic and progressive neurologic deterioration without definite evidences of infection. She developed hypesthetic ataxia, followed by ipsilateral weakness after a weak, and finally encephalopathy after a month. In contrast to the first MRI showing a small longitudinal lesion, the next images revealed massive bilateral frontal lesions with hemorrhagic necrosis and biopsy unveiled inflammatory demyelination.

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Co-occurrence of Guillain-Barré Syndrome and Acute Disseminated Encephalomyelitis with Dual Positive of Anti-GT1a and Anti-GM1 Antibodies (항GT1a 및 항GM1강글리오시드항체 동시 양성을 보인 길랭-바레증후군과 급성파종뇌척수염의 병발)

  • Lee, Juyoung;Yoo, Jinhyuk;Kang, Dong-gook;Kim, Yerim;Yoon, Byeol A;Kim, Jong Kuk;Bae, Jong Seok
    • Journal of the Korean neurological association
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    • v.35 no.4
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    • pp.211-214
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    • 2017
  • Acute disseminated encephalomyelitis (ADEM) and Guillain-$Barr{\acute{e}}$ syndrome (GBS) are both rare post-infectious neurological disorders. The co-existence of these conditions has often been reported despite of low incidence. We describe a 20-year-old male, who presented with acute flaccid paralysis and encephalopathy. The patient showed reversible MRI lesions suggesting ADEM. This case showed anti-GT1a IgG and anti-GM1 IgM antibodies positivity. We suggest that certain immunogenicity within central and peripheral nervous system may share a common autoimmune process during the disease course.