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Acute disseminated encephalomyelitis confined to brainstem
K Tateishi1, K Takeda, T Mannen
1Department of Second Internal Medicine, Tokyo University, Bunkyo-Ku, Hongo 7-3-1, Tokyo 1138655, Japan. ktateish@rinshoken.or.jp
Abstract:
A 21-year-old man was troubled with a subacute history of brainstem involvement and a leukocyte pleocytosis in the cerebrospinal fluid. Magnetic resonance imaging (MRI) demonstrated a massive lesion with Gd enhancement in the pons. Steroid therapy, not antiviral drugs, was dramatically effective for the mass reduction and symptom improvement. Over 4 years no recurrence has been recognized, so this case was diagnosed to be an unusual case of acute disseminated encephalomyelitis (ADEM). ADEM must be included in the differential diagnosis for a brainstem mass in MRI.
Insights
A rare case of acute disseminated encephalomyelitis (ADEM) presented as a brainstem mass. Steroid therapy proved effective, highlighting ADEM
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Brainstem lesions can present with diverse etiologies.
- Leukocyte pleocytosis in cerebrospinal fluid suggests an inflammatory or infectious process.
Observation:
- A 21-year-old male presented with subacute brainstem symptoms and CSF pleocytosis.
- MRI revealed a large, enhancing pontine lesion.
- The patient showed significant improvement with steroid therapy, not antivirals.
Findings:
- The case was diagnosed as an unusual presentation of acute disseminated encephalomyelitis (ADEM).
- Successful management with corticosteroids was observed.
- No recurrence was noted over a 4-year follow-up period.
Implications:
- Acute disseminated encephalomyelitis (ADEM) should be considered in the differential diagnosis of brainstem masses.
- This case underscores the importance of considering neuroinflammatory conditions in unexplained neurological deficits.
- MRI findings combined with clinical presentation and treatment response are crucial for diagnosing atypical ADEM cases.