medigraphic.com
Academia Mexicana de Neurología, A.C.

2006, Number 2

<< Back Next >>

Rev Mex Neuroci 2006; 7 (2)

Clinical and radiological spectrum of acute disseminated encephalomyelitis

Dondis CD, De la Maza FM

Language: Spanish
References: 22
Page: 170-178
PDF size: 226.55 Kb.


ABSTRACT

Objective: To identify the clinical and radiological spectrum of the acute disseminated encephalomyelitis (ADEM) and to make a critical analysis of literature. Patients and method: Prospective revision of patients evaluated in San Jose Hospital Tec of Monterrey between December 2002 and 31of December 2004. Results: Five patients are described, with ages between six and 55 years, with polysintomatic manifestations in single-phase form, related to multiregional cerebral pathology, in white and gray substance by cerebral magnetic resonance (MR). Autoimmunity postinfectious association in two patients is described, postsensitization to strange proteins in another one, and without infectious asso-ciation or postsensitization in the other two. Spectroscopy by magnetic resonance (SMR) application in substitution of the cerebral biopsy in a patient with tumor presentation. The more frequent clinical presentations were motor deficit (100%), ataxia (100%), language alterations (60%), alert status deterioration (60%), cerebellum alterations (40%) and convulsions (40%). The most frequent topography by cerebral MR were fronto/temporo/parietal regions in 80%, basal ganglion (80%) and thalamic injuries (60%). Those patients with alert status alteration had more severe lesional load in white substance and deep gray substance in bihemisphere form. Clinical recurrences of the injuries in the period of pursuit were not observed. Conclusion: A specific biological marker absence and clinical diagnostic guide difficult the differentiation with multiple sclerosis. The most important factors for this distinction are the antecedent of viral prodrome, multiplicity of neurologic symptoms with single-phase course, ataxia beginning in children, a severe lesional load in cerebral MR that involves the white substance and the deep gray, absence of black holes; and, in cephalorrhachidia liquid, absence of oligoclonal bands. The EMR is a useful resource that can avoid the cerebral biopsy in select cases.


REFERENCES

  1. Dale RC, de Sousa C, Chong WK, et al. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain 2000; 123: 2407-22.

  2. Garg RK. Acute disseminated encephalomyelitis: Postgraduate Med J 2003; 79(927): 16.

  3. Dale, et al. Interleukin-6 and oligoclonal IgG synthesis in children with acute disseminated encephalomyelitis. Neuropediatrics 2003; 34(3): 141-5.

  4. Wei TY, Baumann RJ. Acute disseminated encephalomyelitis after Rocky Mountain Spotted fever. Pediatr Neurol 1999; 21: 503-5.

  5. Stonehouse M, Gupte G, Wassmer E, Whitehouse WP. Acute disseminated encephalomyelitis: recognition into the hands of general pediatricians. Archives Dis Childhood 2003; 88(2): 122-4.

  6. Nakamura, et al. Neurologic complications associated with influenza vaccination: two adult cases. Internal Med 2003; 4(2): 191-4.

  7. Tomonari, et al. Acute disseminated encephalomyelitis after allogeneic bone marrow transplantation for AML. Ann Hematol 2003; 82(1): 37-40.

  8. Chaudhuri, et al. Recurrent acute disseminated encephalomyelitis. Curr Med Chem 2003; 10(19): 1945-53.

  9. Murphy SNK, Faden HS, Cohen ME, et al. Acute disseminated encephalomyelitis in children. Pediatrics 2002; 110(2).

  10. Cohen, et al. Recurrence of acute disseminated encephalomyelitis at the previously affected brain. Arch Neurol 2001; 58: 797-801.

  11. Cotton F, Weiner HL, Jolesz FA, Guttmann CR. MRI contrast uptake in new lesions in relapsing-remitting MS followed at weekly intervals. Neurology 2003; 60(4): 640-6.

  12. Schwartz S, Mohr A, Knauth M, et al. Acute disseminated encephalomyelitis. A follow-up study of 40 adult patients. Neurology 2001; 56: 1313-18.

  13. Tenembaum SN, Segura M, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis (ADEM). Prospective study in 79 pediatric patients. Neurology 2000; 54(Suppl. 3): A247.

  14. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983; 13: 227-31.

  15. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121-7.

  16. Rust RS, Dodson W, Prensky A, et al. Classification and outcome of acute disseminated encephalomyelitis. Ann Neurol 1997; 42: 491.

  17. Kimura S, Nezu A, Ohtsuki N, Kobayashi T, Osaka H, Uehara S. Serial magnetic resonance imaging in children with postinfectious encephalitis. Brain Dev 1996; 18: 461-5.

  18. Hynson JL, Kornberg AJ, Coleman LT, et al. Clinical and neuroradiological features of acute disseminated encephalomyelitis in children. Neurology 2001; 56:1 30-12.

  19. Straub J, Chofflon M, Delavelle J. Early high dose intravenous methyl prednisolone in acute disseminated encephalomyelitis: a successful recovery. Neurology 1997; 49: 1145-7.

  20. Rust RS, Dodson W, Prensky A, et al. Classification and outcome of acute disseminated encephalomyelitis. Ann of Neurol 1997; 42: 491.

  21. Markus R, Brew BJ, Successful outcome with aggressive treatment of hemorrhagic encephalitis. J Neurol Neurosurgery Psychiatry 1997; 63: 551-2.

  22. Stricker RB, Miller RG, Kirpov DD Role of plasmapheresis in acute idesminated post infeccious encephalomyelitis. J Clin Apheresis 1992; 7: 173-9.




2020     |     www.medigraphic.com