Acute disseminated encephalomyelitis presenting with hypertensive emergency

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Neuroimmunology

Background:

• Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory demyelinating disease of the central nervous system.
• Autonomic dysfunction, including fluctuations in blood pressure, has been observed in some ADEM cases.
• Hypertensive emergencies are typically associated with other medical conditions, not commonly as a presenting feature of ADEM.

Purpose of the Study:

• To report a unique case of a pediatric patient with ADEM presenting with hypertensive emergency.
• To document the clinical course and management of this rare presentation.
• To expand the understanding of potential neurological manifestations in ADEM.

Main Methods:

• Case report of a 12-year-old female patient.
• Clinical observation of presenting symptoms, including neurological deficits and severe hypertension.
• Monitoring of blood pressure response to antihypertensive medication (oral clonidine).

Main Results:

• The patient presented with symptoms consistent with ADEM and a concurrent hypertensive emergency.
• Hypertension persisted for several weeks post-recovery from the acute ADEM episode.
• Oral clonidine effectively managed the persistent hypertension, which eventually subsided.

Conclusions:

• Hypertensive emergency can be an unrecognised presenting feature of acute disseminated encephalomyelitis in children.
• Prompt recognition and management of hypertension are crucial in ADEM patients.
• This case broadens the spectrum of autonomic instability associated with ADEM.