Related Experiment Videos
Acute disseminated encephalomyelitis in children: clinical, neuroimaging and neurophysiologic studies
1Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, R.O.C.
Insights
Acute disseminated encephalomyelitis (ADEM) can involve the spinal cord and peripheral nerves. Magnetic resonance imaging (MRI) and neurophysiologic studies are crucial for diagnosing ADEM and associated conditions.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimmunology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease affecting the central nervous system.
- Pediatric ADEM cases present with diverse neurological symptoms and varying etiologies.
- Early diagnosis and characterization of ADEM are essential for appropriate management.
Purpose of the Study:
- To retrospectively review clinical findings, neuroimaging, and neurophysiologic studies in pediatric patients diagnosed with ADEM.
- To investigate the prevalence and patterns of central and peripheral nervous system involvement in ADEM.
- To evaluate the diagnostic utility of MRI and neurophysiologic studies in ADEM.
Main Methods:
- Retrospective chart review of nine pediatric patients diagnosed with ADEM.
- Analysis of clinical presentation, laboratory findings, and neuroimaging (CT and MRI).
- Review of neurophysiological studies including electroencephalography (EEG) and evoked potentials (EPs).
Main Results:
- ADEM patients presented with headache, vomiting, altered consciousness, and motor deficits.
- MRI revealed multiple lesions in the brainstem, basal ganglia, thalamus, periventricular white matter, and cerebellum.
- Neurophysiological studies indicated spinal cord involvement in all examined patients and peripheral neuropathy in one.
Conclusions:
- ADEM can be associated with radiculoneuropathy.
- MRI and neurophysiologic studies are complementary diagnostic tools for ADEM.
- Comprehensive neurodiagnostic evaluation is vital for pediatric ADEM patients.
Abstract:
Nine patients below 20 years of age (4 males and 5 females), who were diagnosed to have acute disseminated encephalomyelitis (ADEM) by clinical findings and magnetic resonance imaging (MRI), were reviewed retrospectively. They ranged from 4 months to 20 years of age with an average of 8.6 years. Seven patients (78%) received neurophysiological studies, which included electroencephalography, multimodality evoked potentials (EPs), nerve conduction velocity and/or F-wave measurement. The presentation symptoms were mainly headache, vomiting, consciousness change and motor deficits. Seven (78%) of nine patients had symptoms preceded by fever or upper respiratory tract infections; one (11%) was preceded by trivalent mumps, measles, rubella vaccination and no definite predisposing factor was found in another. Computed tomography (CT) scans were abnormal in five (71 %) of seven children, while MRI showed multiple lesions in seven (78%) of nine children. The lesions in MRI were mainly in the brainstem (n = 6), basal ganglion (n = 5), thalamus (n = 4), periventricular white matter (n = 4) and cerebellum (n = 4). EPs disclosed spinal cord involvement in all patients who received the examination. Peripheral neuropathy was disclosed in one patient. It was concluded that associated radiculoneuropathy is possible in patients with ADEM. Both MRI and neurophysiologic studies are complementary for diagnosis of ADEM.