Acute Disseminated Encephalomyelitis following Thoracic Endovascular Aortic Repair: An unusual presentation

Abstract

Acute disseminated encephalomyelitis (ADEM) is a central nervous system demyelinating condition caused by viral or bacterial infections or immunizations. The postulated aetiology is an autoimmune reaction against myelin components; however, the mechanistic details are yet unknown. We present the imaging findings of a patient who passed away due to the manifestations of acute disseminated encephalomyelitis. The patient initially underwent surgical repair for type B aortic dissection. 2 weeks after he had poor GCS and no motor response following multiple attempts at sedation hold in the intensive care unit. On magnetic resonance imaging, haemorrhagic white matter abnormalities were noted throughout the cerebral hemisphere indicative of an inflammatory demyelinating process. Our case emphasizes the challenges involved in evaluating emerging neurological problems following a period of intubation /sedation amongst these patients. In addition, unlike children, 50% of adult patients do not have illness or immunisation as a trigger event for this condition.