[Acute disseminated encephalomyelitis presented with apnea in the acute stage]

A 33-year-old man was admitted to our hospital because of tetraplegia and dyspnea in November 4, 1991. He had been healthy until October 22, 1991, when he developed difficulty in urination, ascending paralysis, respiratory paralysis and oscillopsia. On admission, neurological examination showed transverse myelopathy below the level of fourth cervical cord segment, opsoclonus and respiratory paralysis, which developed apnea. Cell numbers and protein concentration in CSF were elevated 37/mm3 and 380 mg/dl respectively. MRI disclosed increased signal intensity area at the upper cervical cord and brainstem. From these findings, the patient was diagnosed as acute disseminated encephalomyelitis (ADEM). Cases of ADEM associated with respiratory paralysis in the acute stage are rare. An extended lesion of respiratory upper motor neuron descending from the medulla oblongata to the upper cervical cord may be involved, and resulted in respiratory paralysis in this case.