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Published on: July 4, 2007
Adult onset acute disseminated encephalomyelitis: A case report
Nizar Almaghrabi1, Abeer Saab2
1Radiology resident, King Abdulaziz Hospital, Makkah, Saudi Arabia.
Insights
Adults can develop acute disseminated encephalomyelitis (ADEM), a rare autoimmune disorder affecting the central nervous system. This case highlights ADEM in a 40-year-old male presenting with neurological symptoms and specific MRI findings.
Area of Science:
- Neuroimmunology
- Neurology
- Radiology
Background:
- Acute disseminated encephalomyelitis (ADEM) is typically a post-infectious or post-vaccination autoimmune demyelinating disorder.
- It predominantly affects children aged 5-8 years, with adult onset being rare.
Observation:
- A 40-year-old male presented with agitation, decreased consciousness, delirium, and tonic-clonic seizures.
- Initial presentation was his first neurological episode with no prior medical history.
Findings:
- MRI revealed supra- and infratentorial white matter T2/FLAIR hyperintensities.
- Abnormalities involved supratentorial cortical/subcortical parieto-occipital regions and deep white matter, predominantly in the right temporo-occipital region.
- Juxtacortical and U-fiber involvement was noted, suggesting demyelination.
Implications:
- This case expands the understanding of ADEM presentation in adults.
- Highlights the importance of considering adult-onset ADEM in cases with specific neuroimaging findings, even with atypical presentations.
- Emphasizes the need for thorough exclusion of other conditions mimicking ADEM in adults.
Abstract:
Acute disseminated encephalomyelitis is an immune mediated demyelinating disorder of the central nervous system, it predominantly affects children in the age group between of 5-8 years. Is most widely thought to be a post-viral, post-vaccination autoimmune phenomenon. We present a case of 40 years old Pakistani male arrived to ER agitated with decrease level of consciousness and delirium, develop tonic-clonic convulsion and it was relieved by DIAZEPAM. This is the first attack to the patient with no past medical history of similar presentation. MRI showed supra and infratentorial white matter high T2/FLAIR signal abnormalities, involving supratentorial cortical and subcortical parito-occipital region, also to less extent at deep white matter predominantly right tempro-occipital region in asymmetric pattern. Involvement of juxta cortical and U fibers. MRI raised the possibility of adult onset Acute disseminated encephalomyelitis, after exclusion of other causes of juxta cortical and U fibers involvement (based on imaging analysis with consideration of clinical presentation and available lab results).
