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Cranial computed tomography in acute disseminated encephalomyelitis
1Department of Neurology, Chang Gung Memorial Hospital, Tapai, Taiwan, Republic of China.
Abstract:
Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory disorder of the nervous system. The appearance of ADEM on cranial CT scans has rarely been reported. The author reports seven cases in two institutions during a period of seven years. Only four of the seven patients had hypodense lesions in the white matter and six patients showed spotty, nodular, or gyral enhancement after contrast injections. The enhancement resolved with steroid therapy, leaving some persistent hypoattenuated areas even after 10 months follow-up, these findings support the dual components of the pathogenesis of ADEM. The vasculitic component may be responsive to steroids, nevertheless the demyelinating or necrotic areas may not, and the latter may be responsible for the sequelae of ADEM.
Insights
Acute disseminated encephalomyelitis (ADEM) is a rare nervous system inflammation. Cranial CT scans in seven patients revealed lesions and contrast enhancement, suggesting a dual pathogenesis responsive to steroids.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory neurological disorder.
- Cranial CT findings in ADEM are rarely documented.
- Understanding ADEM's imaging characteristics is crucial for diagnosis and management.
Purpose of the Study:
- To report the cranial CT scan appearance of ADEM.
- To correlate imaging findings with clinical presentation and response to therapy.
- To explore the pathogenetic basis of ADEM based on imaging and treatment response.
Main Methods:
- Retrospective review of seven ADEM cases over seven years across two institutions.
- Analysis of cranial CT scans, including pre- and post-contrast imaging.
- Correlation of imaging findings with steroid treatment response and follow-up.
Main Results:
- Only four of seven patients exhibited hypodense white matter lesions on CT.
- Six patients showed spotty, nodular, or gyral enhancement post-contrast.
- Enhancement resolved with steroid therapy, but hypoattenuated areas persisted in some patients up to 10 months.
Conclusions:
- ADEM imaging findings suggest a dual pathogenesis involving a steroid-responsive vasculitic component and potentially non-responsive demyelinating/necrotic areas.
- Persistent hypoattenuated areas post-treatment may indicate sequelae related to demyelination or necrosis.
- CT imaging can provide insights into ADEM's pathophysiology and predict long-term outcomes.