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2003, Number 3

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Rev Neurol Neurocir Psiquiat 2003; 36 (3)

Differential diagnosis of acute disseminated encephalomyelitis and multiple sclerosis. A case report and review of the literature

Salazar ZA, Pérez RM, Ramos RE, Aguilar GÓR, Sosa BJA, Flores HR

Language: Spanish
References: 77
Page: 138-144
PDF size: 138.49 Kb.


ABSTRACT

We report the clinic case of a 16 years-9 months old male patient who was diagnosed with probable multiple sclerosis at admission. Subsequently, a definitive diagnosis of acute disseminated encephalomyelitis (ADEM), after an acute upper respiratory tract infection, associated with cytomegalovirus, at the Department of Neurology and Neurosurgery at the Military Central Hospital, caused by an acute upper respiratory tract infection due to cytomegalovirus. Acute disseminated encephalomyelitis is an infrequent, inflammatory, demyelinizating and autoimmune disorder of the central nervous system that usually affects children and young adults; however, there are some cases reported in older adults. This is a monophasic disorder with good outcome in the most of cases with the current treatment, which includes methylprednisolone, intravenous immunoglobulin and plasmapheresis. It is a polisymptomatic neurological disease commonly associated with viral and bacterial infections and after immunization, but sometimes without previous infection, too. ADEM results from a transient autoimmune response towards myelin or another autoantigens, possibly via molecular mimicry, or by non-specific activation of autoreactive T cell clones. We performed a review of the literature on acute disseminated encephalomyelitis with the purpose of demonstrating the main clinical, laboratory tests and radiological imaging findings that allow us to define the early diagnosis, with the objective of discard a first attack of multiple sclerosis, and to avoid an acute depressive episode in these patients secondary to diagnosis of multiple Rocosclerosis, and to avoid also a long-term treatment with beta interferons or glatiramer acetate, because these therapies are unnecessary and expensive.


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