Medical and surgical management of acute disseminated encephalomyelitis
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B D Ellis1, G S Kosmorsky, B H Cohen
1Department of Ophthalmology, Cleveland Clinic Foundation, Ohio.
Insights
Two children with viral illness developed optic neuritis, a complication of acute disseminated encephalomyelitis (ADEM). Treatment with corticosteroids and surgical interventions led to symptom resolution and vision recovery.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Optic neuritis can be a presenting sign of acute disseminated encephalomyelitis (ADEM) in children.
- Viral illnesses are a common preceding factor in pediatric ADEM cases.
Observation:
- Two children presented with vision loss due to optic neuritis following a viral infection.
- Clinical and neuroimaging findings were consistent with ADEM, complicated by markedly elevated intracranial pressure.
Findings:
- Initial treatment with high-dose corticosteroids yielded a favorable response, but symptoms recurred upon tapering.
- Recurrence necessitated reinstitution of corticosteroids and surgical interventions: optic nerve sheath decompression in one patient and a lumboperitoneal shunt in the other.
Implications:
- Aggressive management, including corticosteroids and surgical decompression or shunting, can be effective in managing recurrent optic neuritis secondary to ADEM.
- Prompt diagnosis and intervention are crucial for visual recovery in pediatric patients with ADEM-related optic neuritis.
Abstract:
Two children with a recent history of viral illness developed visual loss secondary to optic neuritis. Clinical findings and neuroimaging were consistent with acute disseminated encephalomyelitis (ADEM). Markedly elevated opening pressures were noted on lumbar puncture. The patients demonstrated an initial favorable response to high-dose corticosteroid administration. Both had recurrence of symptoms after being tapered off oral corticosteroids. High-dose corticosteroids were reinstituted and a bilateral optic nerve sheath decompression was performed on one patient who developed profound visual loss. A second patient underwent a lumboperitoneal shunt. Both children had resolution of their symptoms and had a recovery of normal visual acuity.