An Adult Case of Multiphasic Disseminated Encephalomyelitis Manifesting with Optic Neuritis

Abstract

A 25-year-old woman presented with a fever, headache, vomiting and somnolence. Cranial magnetic resonance imaging (MRI) showed multiple lesions in the cerebellum, brainstem, cerebral cortex and subcortex. Oligoclonal bands were positive in the cerebral spinal fluid (CSF). She experienced a good recovery after steroid treatment. Four months later, she developed right vision loss. Repeated MRI showed multiple cranial lesions different from those involved in the first attack in both size and distribution. An abnormal high signal was also observed in the front and intraorbital regions of the right optic nerve. The patient's vision progressively improved, and she obtained a full recovery following the administration of steroids. A diagnosis of multiphasic disseminated encephalomyelitis manifesting with optic neuritis was made.

Atypical Presentation of Acute Disseminated Encephalomyelitis (ADEM) in a Middle-Aged Adult

“…Examination of the cerebrospinal fluid (CSF) in patients with ADEM is usually normal, but some patients may have an increased opening pressure, lymphocytic pleocytosis, but with normal CSF glucose. Oligoclonal bands in the CSF may also be found in patients with ADEM, but they are more commonly seen in patients with MS patients [9,10]. Treatment with methylprednisolone and supportive management remain the mainstay of treatment for ADEM, but immunomodulation and plasmapheresis have been used successfully in some refractory cases.…”