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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute disseminated encephalomyelitis, an inflammatory and demyelinating disorder of central nervous system white matter, typically occurs following childhood viral infections. Although CT may demonstrate abnormalities, many children have normal CT studies in spite of widespread neurologic abnormalities. We report a series of five patients with the typical clinical presentation of disseminated encephalomyelitis who were studied using magnetic resonance imaging (MRI). In each case the children presented with progressive subacute neurologic abnormalities including headache, diplopia, ataxia, hemiparesis, seizures, dysarthria, and/or coma. CT was nondiagnostic. MRI clearly demonstrated multifocal white matter lesions of the cerebrum, brainstem, and cerebellum which corresponded to clinical signs. The patients improved dramatically with corticosteroid therapy. MRI showed progressive resolution of multifocal lesions in conjunction with clinical improvement.
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PMID:MRI in children with postinfectious disseminated encephalomyelitis. 395 36

Acute disseminated encephalomyelitis is a rare central nervous system demyelinating disease that occurs most frequently in children. It usually runs a monophasic course, beginning with fever, headache, and meningeal signs and rapidly progressing to coma when appropriate diagnosis and treatment are not provided. We report a case of a 14-year-old patient to alert emergency physicians to consider acute disseminated encephalomyelitis when presented with any child with encephalitic signs with nonspecific cerebrospinal fluid findings, failure to detect any causative agent, and only mild alterations on computerized tomography scan. The role of magnetic resonance imaging for the diagnosis is emphasized.
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PMID:Acute disseminated encephalomyelitis: an unusual cause of encephalitic syndrome in childhood. 951 30

Japanese encephalitis (JE) vaccine has been used for childhood immunization programmes in Asia since the 1960s. Also, travellers from other parts of the world have been vaccinated before travelling to Asian countries. Some JE vaccines are produced from infected mouse brains and contain small amounts of myelin basic protein. Neurological side effects in larger vaccine trials in Asia have been reported in 1-2.3 per million vaccinees. Statens Serum Institut is the only distributor of JE vaccine in Denmark, delivering 384 000 doses from 1983-96. In 1996, evaluation of initial symptoms and findings in 10 adult travellers from Denmark, who developed moderate-severe neurological symptoms within a few weeks of JE vaccination, was performed as well as follow-up magnetic resonance imaging (MRI) and clinical neurological examination. Three patients initially had symptoms varying from severe encephalitis-like illness to paraesthesia, double vision or parkinsonian gait disturbance. MRI showed severe atrophy of the corpus callosum with altered signal intensity indicating gliosis in one patient, another patient had several hyperintense spots located periventricularly in the white matter, while a third patient had spots with increased signals in the pons, the right substantia nigra and the occipital region. Acute disseminated encephalomyelitis (ADEM) is a possible explanation for these MRI changes, although multiple sclerosis is an alternative diagnosis in one or two of the patients. Another three patients had long-lasting headache, concentration difficulty or intellectual reduction. One man had afebrile convulsions, another gait instability and depression and one parkinsonism. A woman developed myelitis. If these findings are due to JE vaccination the frequency of neurological reactions to the vaccine is considerably higher than previously reported and in the future any minor neurological complaints occurring shortly after vaccination should lead to neurological examination and acute MRI scan should be considered. Copyright 1998 Lippincott Williams & Wilkins
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PMID:Neurological complications to vaccination against Japanese encephalitis. 1021 Aug 77

A 10-year-old boy presented with fever, headache, vomiting, and hypersomnolence. An akinetic-rigid syndrome with tremor, dysphagia, dysphonia, and sialorrhea, as well as pyramidal signs, developed. Slightly elevated protein content was found in the cerebrospinal fluid and serological investigations were suggestive of a primary Epstein-Barr virus infection. Magnetic resonance imaging (MRI) showed massive bilateral hyperintense striatal and punctiform periventricular lesions. After 2-month treatment with steroids and antiparkinsonian drugs, all features resolved without sequelae. Control MRI demonstrated only minimal residual lesions in both putamina. Strongly resembling the encephalitis lethargica-like syndrome, this case is an unusual presentation of parainfectious acute disseminated encephalitis.
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PMID:Acute reversible parkinsonism in Epstein-Barr virus-related encephalitis lethargica-like illness. 1625 20

A 37-year-old man presented with acute dizziness, nausea, headache and fever. Later on, he developed diplopia, swallowing difficulties, numbness and ataxia. MRI on day 6 showed hypo-intense, contrast-enhancing lesions on TI-weighted scans in the brainstem and cerebellum. Cerebrospinal fluid (CSF) findings on day 6 included pleiocytosis, a mildly-elevated protein level and mildly-decreased glucose level. CSF and blood cultures were initially negative for both bacteria and viruses. Acute disseminated encephalomyelitis (ADEM) was suspected and dexamethasone therapy was started. On day 26, a blood culture was positive for Listeria monocytogenes. The diagnosis 'Listeria rhombencephalitis' was made and the patient was treated with amoxicillin. This resulted in good recovery. In patients with a subacute onset of progressive cranial nerve dysfunction, ataxia, CSF pleiocytosis, and MRI lesions in the brainstem and cerebellum, Listeria rhombencephalitis should be considered. Early diagnosis and treatment improve the prognosis.
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PMID:[Rhombencephalitis due to Listeria monocytogenes]. 1790 63

Torticollis can be either congenital or acquired. Acquired torticollis is often the manifestation of an underlying central nervous system disorder. Acute painless torticollis should always raise suspicion of a posterior fossa tumor. Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system involving the subcortical white matter, and to a lesser extent, the gray matter. The illness typically has a monophasic course characterized by a variable combination of fever, headache, meningismus, seizures, spasticity, cranial nerve palsies, ataxia, and psychosis. The course, although often clinically severe, is generally benign with most children making a full recovery. A toddler presenting with subacute painless torticollis as the only manifestation of acute disseminated encephalomyelitis is described. The authors believe the neck twist in this child represented a form of dystonia because of basal ganglia involvement. Torticollis has not been reported as a presenting or only sign of disseminated encephalomyelitis.
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PMID:Torticollis as the only manifestation of acute disseminated encephalomyelitis. 2060 59

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory central nervous system disorder characterized by acute or subacute onset of multifocal neurologic deficits with headache and impaired conscious level. Acute haemorrhagic leuoko-encephalitis (AHEM) is a more sever, often fatal variant. These disorders often follows a viral illness or vaccination, and are usually monophasic, though (probably more commonly in childhood) a multiphasic variant of ADEM is recognized. Because of the relative non-specificity of the clinical presentation (a sub-acute encephalopathy with focal signs), the differential diagnosis is wide; and distinction from the first episode of relapsing-remitting multiple sclerosis can occasionally be difficult. Here the clinical and investigational features of these disorders and their treatment are discussed.
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PMID:Acute disseminated encephalomyelitis and other inflammatory demyelinating variants. 2450 37

Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system that usually occurs following an antecedent infection or vaccination. Children and young adults are predominantly affected, but it has low incidence in children younger than 3 years. The disease manifests with a wide range of neurological abnormalities and a variable combination of fever, headache, meningism, convulsion and cranial nerve palsies, and there are no pathognomonic clinical or laboratory findings. So, establishment of definitive diagnosis is challenging in infants. This challenge may result in delayed diagnosis and consequently delayed treatment of acute disseminated encephalomyelitis, which may cause permanent neurological disability. Herein, we report an infant with acute disseminated encephalomyelitis, who mimicked the symptoms of meningoencephalitis and the correct diagnosis and treatment were delayed till the development of a severe phase of the disease.
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PMID:Acute disseminated encephalomyelitis mimicking acute meningoencephalitis. 2469 5

Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both CNS inflammatory demyelinating diseases with overlapping clinical features. A case is reported of a 51-year-old female who presented with headache, progressive aphasia and hemiparesis without preceding infection or vaccination. Brain MRI revealed multiple, often confluent, subcortical white matter lesions without enhancement, affecting predominantly the left cerebral hemisphere. CSF examination failed to reveal oligoclonal bands. Brain biopsy revealed both pathological features of ADEM and findings are consistent with the early stage of MS, including meningeal B and T lymphocytic infiltration, perivenular demyelination, subpial demyelination and discrete confluent plaque-like foci of demyelination. Steroid treatment resulted in remarkable clinical and radiological improvement and there has been no recurrence in six years of follow-up. This case highlights the difficulties in differentiating between ADEM and the first attack of MS and further suggests that ADEM and the early stage of MS, and its tumefactive variant, may have a common underlying pathologic mechanism, which may have a therapeutic implication in treating these diseases.
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PMID:Meningeal inflammation and demyelination in a patient clinically diagnosed with acute disseminated encephalomyelitis. 2521 55

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated disease of the brain that follows viral infection or vaccination, or even appears spontaneously. The objective of the study was to evaluate the clinical, neuroimaging and laboratory profiles of children with ADEM. Seventeen children admitted to the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, whose cases were consistent with the diagnosis of ADEM, were included. Their clinical and neuroimaging profiles and outcomes were studied. The most common presenting features were fever (71%), altered sensorium (59%) and headache and convulsions (41%). Brain MRI identified lesions in subcortical white matter (75%) and periventricular white matter (38%). Most patients were treated with corticosteroids. A favorable outcome was seen in 88% of patients. Although 59% of patients had neurologic sequelae at discharge, only one patient had a major neurological deficit at follow-up. Prognosis for survival and outcome was good in the majority of patients. Neurological sequelae at discharge do not predict poor outcome.
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PMID:Outcome of children with acute disseminated encephalomyelitis in a tertiary care center in India. 2602 86


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