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Neuroimaging features of acute disseminated encephalomyelitis in childhood
Lawrence P Richer1, D Barry Sinclair, Ravi Bhargava
1Division of Neurology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
Early resolution of central nervous system demyelination in children on MRI suggests acute disseminated encephalomyelitis. Incomplete resolution correlates with poorer neurologic outcomes.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Radiology
Background:
- Acute and disseminated demyelination in children presents diagnostic challenges.
- Identifying the cause is crucial for appropriate management and prognosis.
Purpose of the Study:
- To evaluate the association between the resolution of magnetic resonance imaging (MRI) abnormalities and clinical outcomes in pediatric patients presenting with acute disseminated encephalomyelitis (ADEM).
- To explore the diagnostic utility of MRI findings in differentiating ADEM from other demyelinating conditions.
Main Methods:
- Retrospective cohort study of 10 pediatric patients (5-17 years) with a presenting diagnosis of ADEM.
- Serial MRI studies were analyzed to track the evolution of T(2) prolongation (demyelination).
- Clinical and neurological follow-up data were correlated with MRI findings over a mean follow-up of 334.2 days.
Main Results:
- Early resolution of MRI signal abnormalities within 6 months was commonly associated with ADEM but did not reach statistical significance (P=0.083).
- Incomplete resolution of MRI abnormalities showed a statistically significant association with abnormal neurological outcomes (P=0.048).
- Complete resolution of MRI signal abnormalities was significantly associated with normal neurological outcomes.
Conclusions:
- Early MRI resolution or recurrent demyelination within 6 months may suggest ADEM in children, though statistical significance was not met.
- Persistent MRI signal abnormalities are a significant predictor of adverse neurological outcomes in pediatric demyelinating events.
- Complete resolution of MRI findings is a favorable prognostic indicator for neurological recovery in pediatric ADEM.
Abstract:
Acute and disseminated demyelination of the central nervous system in children may have many causes. This study reports a retrospective cohort of 10 consecutive pediatric cases (5 to 17 years; mean [S.D.] 12.1 [4.3] years) with a presenting diagnosis of acute disseminated encephalomyelitis and the clinical and radiologic follow-up. The evolution of magnetic resonance imaging abnormalities was determined from serial studies in nine patients with a mean (S.D.) follow-up of 334.2 (312.8) days. Resolution of magnetic resonance imaging T(2) prolongation (i.e., demyelination) within 6 months of presentation was associated most commonly with a final clinical diagnosis of acute disseminated encephalomyelitis (including the multiphasic form), but failed to meet statistical significance (Fisher's exact test; P = 0.083). Incomplete resolution of the magnetic resonance imaging signal abnormalities yielded a statistically significant association (Fisher's exact test; P = 0.048) with an abnormal neurologic outcome. In summary, we conclude that early resolution of magnetic resonance imaging signal abnormalities or recurrent demyelination within 6 months of an acute and disseminated demyelinating event suggests the diagnosis of acute disseminated encephalomyelitis in children, although this association failed to meet statistical significance. However, a statistically significant association between complete resolution of magnetic resonance imaging signal abnormalities and a normal neurologic outcome was observed.
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