Acute Disseminated Encephalomyelitis with Bilateral Thalamic Necrosis

Dardiotis, Efthimios; Kountra, Persa; Kapsalaki, Eftychia Z.; Πρωτόγερου, Γεωργία; Μarkopoulou, Κaterina

doi:10.1177/0883073808331364

Cited by 7 publications

(2 citation statements)

References 12 publications

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“…Additionally, although previous studies of bilateral thalamic lesions associated with acute disseminated encephalomyelitis have shown relatively good outcome, one case report described a 16-year-old girl with complications associated with acute disseminated encephalomyelitis with bilateral thalamic necrosis and severe neurologic deficits. 1,2,13 Although our patient had complications associated with brainstem and bilateral thalamic lesions, and can be thought to have poor prognosis, he survived without further neurologic sequelae after treatment with methylprednisolone, intravenous immunoglobulin, and hypothermia. Acute therapy for acute disseminated encephalomyelitis has not been thoroughly studied, but corticosteroids are generally considered as the firstline therapy.…”

Section: Discussionmentioning

confidence: 77%

Therapeutic Hypothermia With the Use of Intracranial Pressure Monitoring for Acute Disseminated Encephalomyelitis With Brainstem Lesion

et al. 2013

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Acute disseminated encephalomyelitis confined to the brainstem is associated with poor prognosis. We describe a case of a 10-year-old boy with acute disseminated encephalomyelitis in the brainstem that developed after influenza A infection. A 10-year-old boy presented with fever and prolonged disturbance of consciousness and was admitted to our hospital. Magnetic resonance imaging (MRI) of the midbrain, with T2-weighted and fluid-attenuated inversion recovery images, suggested acute disseminated encephalomyelitis accompanied by a brainstem lesion. Lumbar puncture showed pleocytosis and increased protein content, including myelin basic protein, interleukin-6, and immunoglobulin G, all suggestive of acute disseminated encephalomyelitis. Treatments such as methylprednisolone pulse therapy, intravenous immunoglobulin, and therapeutic hypothermia were performed. Although the patient presented with anisocoria with increased intracranial pressure monitoring during hypothermia, prompt therapy with d-mannitol and dopamine was effective. Our case results suggest that hypothermia could be included in the choice of therapy for acute disseminated encephalomyelitis with brainstem lesions.

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Section: Discussionmentioning

confidence: 77%

Therapeutic Hypothermia With the Use of Intracranial Pressure Monitoring for Acute Disseminated Encephalomyelitis With Brainstem Lesion

et al. 2013

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“…Although our hospital is specialized in neurology and neurosurgery, some kinds of thalamic diseases were absent in our study, including H1N1 infection-associated ANE ( 28 , 29 ), multiple sclerosis ( 30 ), atezolizumab-induced encephalitis ( 31 ), West Nile encephalitis ( 20 ), Reye syndrome ( 32 ), and acute disseminated encephalomyelitis ( 33 ), which may be due to their low prevalence, atypical appearance, or selection bias in the respective studies.…”

Section: Discussionmentioning

confidence: 89%

Volume mismatch indicates tumors in paramedial bithalamic diseases: a retrospective study

Lu¹,

Gao²

2023

Front. Neurol.

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ObjectiveThis study aimed to investigate the diagnostic performance of volume mismatch sign on discriminating paramedial bithalamic tumors from non-tumors.MethodsIn this study, we recruited patients with tumors or non-tumors of the paramedial bithalamus. We confirmed the diagnosis by pathology, laboratory tests documented in medical records, medical imaging at the baseline, or through at least 1 year of follow-up. Cases with paramedial thalamic lesions on only one side or purely midbrain illnesses were excluded. Additionally, any case without involvement of the medial thalami (i.e., those with one or both-sided anterior, lateral, or posterior thalamic lesions) was excluded. Two neuroradiologists were trained independently to evaluate volume mismatch sign on magnetic resonance T2-weighted images or T2 fluid-attenuated inversion recovery images. A positive volume mismatch sign means that the ratio of the larger-sided lesion volume to the smaller-sided lesion volume is >150%. The volume of each lesion was calculated by multiplying the anteroposterior diameter by the left-right diameter and by the height of the lesion and then dividing by 2. The kappa value was calculated to show the consistency between the two observers. The chi-square test was used to evaluate differences in volume mismatch sign between the bilthalamic midline tumor and non-tumor groups. The positive (PPV) and negative (NPV) predictive values, sensitivity, and specificity were calculated to evaluate the ability of volume mismatch sign to differentiate paramedial bilateral thalamus tumors from non-tumors. A two-tailed P ≤ 0.05 was considered to be statistically significant. The analyses were performed using the statistical software SPSS version 26.ResultsA total of 96 patients were enrolled in this study between March 2012 and October 2022. A high agreement between the two observers on the volume mismatch sign of bilateral paramedian thalamic diseases was found, and the Kappa value was 0.828. A statistically significant difference was observed for the volume mismatch sign between the paramedial bithalamic tumor and the non-tumorous groups (χ2 = 35.465, P < 0.001). The presence of volume mismatch sign in paramedial bithalamic illnesses predicted the presence of tumors with a sensitivity and specificity of 69.2% and 90.9%, respectively, and PPV and NPV were 90.0% and 71.4%.ConclusionVolume mismatch sign may indicate tumors in paramedian bithalamic diseases.

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