Aseptic meningitis as initial presentation of acute disseminated encephalomyelitis

Fujiki, Fujio; Tsuboi, Yoshio; Hori, Tomohiko; Yamada, Tatsuo

doi:10.1016/j.jns.2008.05.010

Cited by 17 publications

(6 citation statements)

References 6 publications

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“…Due to the limited number of cases and diagnostic di culties, it is unclear if meningoencephalitis progressing to ADEM is a truly rare event or just underreported. Moreover, the causative microorganism can be identi ed only in a small number of patients, making it di cult to identify risk factors and pathogenetic mechanisms (33,40,41). Streptococcus pneumoniae has been rarely described, and the development of related demyelinating CNS disease is reported only after serious infections, like meningitis.…”

Section: Discussionmentioning

confidence: 99%

Acute Disseminated Encephal Omyelitis (ADEM) After Pneumococcal Meningitis In A Child

Foiadelli¹,

Trabatti²,

Bassanese³

et al. 2020

Preprint

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Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system (CNS), whose pathogenesis is still debated. It occurs more frequently in children, and the first neurological symptoms usually appear between 2 and 4 weeks after a trigger event, such as an infection or vaccination. Several viral agents have been related to the development of ADEM, while bacteria and parasites are less frequently involved. Severe Streptococcus pneumoniae infection has been rarely described as a trigger for CNS demyelination in particularly predisposed subjects.Case presentation: A 10 year old girl was evaluated for headache, fever and vomit. CSF analysis revealed pleocytosis and presence of S. pneumoniae antigen, and proper antibiotic therapy for bacterial meningitis was started, with rapid improvement. A breach in the right frontal bone, due to a car accident occurring the previous year, was considered the gateway for pneumococcal infection. Three days after admission, the girl developed drowsiness, altered speech and left hemiparesis. Brain MRI showed multiple T2-hyperintense bilateral lesions in the supratentorial white matter, and ADEM was diagnosed. Considering the underlying bacterial meningitis, intravenous immunoglobulins were preferred to steroid therapy, and the patient progressively recovered. However, due to recurrence of encephalopathic symptoms after 11 days, high-dose intravenous steroid therapy was performed. The neurological outcome was favourable, with complete regression of the white matter lesions after 4 months and absence of relapses over a follow-up period of 2 years.Conclusions: Occurrence of ADEM following pneumococcal meningitis is rare, and very few cases have been described in children. It should be suspected in case of persistence, recurrence or onset of new symptoms despite adequate antimicrobial treatment, relying on brain MRI for a thorough differential diagnosis. High level of surveillance is mandatory in patients with predisposing factors to invasive pneumococcal disease. In some cases, acute demyelination can occur few days after the onset of meningitis; pathogenetic mechanisms are not yet fully clarified and the choice of the correct therapeutic approach can be challenging.

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Section: Discussionmentioning

confidence: 99%

Acute Disseminated Encephal Omyelitis (ADEM) After Pneumococcal Meningitis In A Child

Foiadelli¹,

Trabatti²,

Bassanese³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…ADEM and hyponatremia are often associated with one another. 10 Author contributions O. Hensel: idea and drafting of the manuscript. P. Niroul: acquisition of data and critical revision of manuscript for intellectual content.…”

Section: Discussionmentioning

confidence: 99%

High-altitude cerebral edema or acute demyelinating encephalomyelitis in the Himalayas

et al. 2018

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A healthy, nonacclimatized 56-year-old woman developed mood changes and general weakness followed by vomiting, sensory disturbances, and ultimately unconsciousness within hours during an ascent from 1,600 to 2,800 meters in the Himalayas, Nepal. She reported no headache, ataxia, or visual disturbances during and following the hike, as confirmed by fellow travelers. As high-altitude cerebral edema (HACE) was suspected, she received 8 mg of dexamethasone and was transferred to a hospital specializing in acute mountain sickness (AMS) located at 1,300 meters. During the transfer, she had a generalized seizure. The next morning, her consciousness was still clouded. She exhibited subtle, brief, involuntary muscle twitching in both arms and neck. Because she responded properly to stimuli, this was interpreted as myoclonus. Laboratory testing revealed serum hyponatremia (117 mmol/L), hyposmolarity, and urine hyperosmolality. These disturbances were associated with decreased urine volume, high positive fluid balance, anadipsia, and weight gain. Her history revealed multiple prior vaccinations but no infections.

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“…It has also been reported in patients with infectious meningitis, encephalitis, central nervous system tumors, as well as following central nervous system surgery [7][8][9]. Rare cases have been described to have intracranial autoimmune inflammatory diseases such as ADEM [10]. Maesaka et al [11,12] carefully studied CSWS and noted that this condition can occur in patients without cerebral disease, such as acquired immunodeficiency syndrome (AIDS), cancer, or pulmonary disease.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia associated with demyelinating disease of the nervous system

et al. 2013

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A 63-year-old man was diagnosed with periodontitis and underwent tooth extraction. Several days later, he suffered a high fever, ischuria, a change in personality, and disorientation. A urologist examined him and found severe hyponatremia (117 mEq/L), and he was then transferred to our hospital. On admission, physical findings revealed dysfunction of the bladder and bowel, altered mental status, and hypovolemia. Blood chemistry showed serum sodium of 120 mEq/L, a serum urate of 1.4 mg/dL, urinary Na of 61 mEq/L, and fractional urate excretion of 16 %. Examination of the cerebrospinal fluid (CSF) showed monocytosis. Magnetic resonance imaging (MRI) of the brain and spinal cord showed multiple lesions characterized by hyperintensity on T2-weighted sequences, suggesting demyelinating disease. His sodium concentration normalized 3 days after volume replacement therapy, and his altered mental status along with the dysfunction of the bladder and bowel were promptly improved after the initiation of high-dose glucocorticoids. Additionally, the abnormal lesions on MRI markedly

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Aseptic meningitis as initial presentation of acute disseminated encephalomyelitis

Cited by 17 publications

References 6 publications

Acute Disseminated Encephal Omyelitis (ADEM) After Pneumococcal Meningitis In A Child

Acute Disseminated Encephal Omyelitis (ADEM) After Pneumococcal Meningitis In A Child

High-altitude cerebral edema or acute demyelinating encephalomyelitis in the Himalayas

Hyponatremia associated with demyelinating disease of the nervous system

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