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A residual cystic lesion in acute disseminated encephalomyelitis
1Department of Paediatrics, Otsu Red Cross Hospital, Nagara, Japan. masumigo@mbox.kyoto-inet.or.jp
Abstract:
We report a case of acute disseminated encephalomyelitis (ADEM) with a residual cystic lesion on MRI. This seemed to be induced by Japanese encephalitis vaccination. Despite complete clinical improvement with high-dose steroid therapy, the cystic lesion has persisted for 3 years on MRI. There have been no previous reports of residual cystic lesions in ADEM.
Insights
Acute disseminated encephalomyelitis (ADEM) following Japanese encephalitis vaccination can lead to persistent cystic lesions. This rare MRI finding, observed in a patient with full clinical recovery, highlights a unique long-term consequence of ADEM.
Area of Science:
- Neurology
- Immunology
- Vaccinology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disease.
- Vaccine-associated ADEM is a rare but recognized neurological complication.
- Japanese encephalitis vaccination is generally safe, with neurological adverse events being infrequent.
Observation:
- A case of ADEM following Japanese encephalitis vaccination is presented.
- The patient exhibited complete clinical recovery after high-dose steroid treatment.
- Persistent cystic lesions were observed on serial Magnetic Resonance Imaging (MRI) scans for 3 years post-vaccination.
Findings:
- This case represents the first documented instance of a residual cystic lesion in ADEM.
- The cystic lesion's persistence despite clinical improvement suggests a unique pathological sequela.
- The findings indicate a potential long-term structural change in the brain following vaccine-induced ADEM.
Implications:
- This report expands the spectrum of potential long-term MRI findings in ADEM.
- Further research is needed to understand the pathogenesis and clinical significance of these residual cystic lesions.
- Clinicians should be aware of rare persistent neurological sequelae after vaccination-induced ADEM.