Acute disseminated encephalomyelitis

Abstract

Acute disseminated encephalomyelitis (ADEM) is typically a monophasic, demyelinating disease of the CNS that predominantly affects children. Typically, its clinical symptoms follow an infection or vaccination. In this regard, numerous viral and bacterial pathogens as well as several vaccinations have been associated with ADEM. Studies from animal models suggest that primary and secondary autoimmune responses may contribute to CNS inflammation and demyelination in ADEM. The diagnosis of ADEM is strongly suggested by a close temporal relationship between a viral infection or immunization and the onset of neurologic symptoms, and it is supported by extensive, multifocal, subcortical white-matter disease on brain magnetic resonance imaging. While mild lymphocytic pleocytosis and elevated proteins are detectable in the CSF in ADEM, oligoclonal bands are not always present. Treatment of this disorder consists of anti-inflammatory and immunosuppressive therapies, and the prognosis is generally considered favorable.

Neurosurgical intervention in an unusual case of extensive acute disseminated encephalomyelitis – A case report and literature review

“…[ 16 ] CSF analysis may show non-specific changes in the form of increased cell count and protein content, especially the immunoglobulin level. [ 18 ]…”

“…[16] CSF analysis may show nonspecific changes in the form of increased cell count and protein content, especially the immunoglobulin level. [18] High dose of intravenous steroids, intravenous immunoglobulin, and plasmapheresis is the main treatment lines in the acute stage. [2] A good prognosis and proper functional recovery is anticipated in cases treated aggressively.…”

Unusual and Dramatic Presentation of “Adem”: What Could Be Done in Neurosurgical Practice?

“…In many instances, the immunoglobulin level is also elevated but oligoclonal bands are seen only rarely. 33,34 In any case, when ADEM is suspected, it is very important to avoid dangerous delay as its differential diagnosis is quite difficult especially in the acute stage.…”