Domínguez-Moreno R, Peña-Pérez CA, Carrillo-Esper R, Flores-Silva D, Albores-Saavedra J

Language: Spanish
References: 21
Page: 768-775
PDF size: 604.09 Kb.

ABSTRACT

Acute disseminated encephalomyelitis has a low frequency especially in adults, and its demyelinating immunologic nature is usually single and can present data suggesting multifocal disease of the central nervous system, which represents a diagnostic challenge among neuroinfections, vasculitis, multiple sclerosis and other infrequent entities. This paper reports the case of a 45-year-old male previously healthy, who had a history of an upper respiratory tract infection three weeks prior to admission; he began with drowsiness, fever and headache for 10 days, and was initially treated as a neuroinfection for eight days; he continued with persistent fever, akinetic mutism and stupor; he was admitted to our institution where CT brain scan reported a nonspecific diffuse frontal bilateral lesions which predominated on the temporal lobe and lumbar puncture which reported nonspecific inflammation; MRI was performed reporting diffuse white matter lesions alongside data that suggested bleeding. Neuroinfection, autoimmune disease and vasculitis were discarded, and the findings in the biopsy were compatible with acute disseminated encephalomyelitis, initial treatment was with corticosteroids that improved alertness and expression based on monosyllables. Decision was made to continue rehabilitation and treatment at another institution. An internist must considered this in all patients with the acute development of neurological signs and symptoms, supported with evidence of multifocal hyperintense lesions on MRI without other apparent cause, especially infectious one. Although it is a benign condition in most cases, proper and timely treatment should be installed as soon as possible to avoid neurological sequelae.

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