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Category: Volume 10 Issue 10 October 2022
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Title: Extensive acute disseminated encephalomyelitis with spinal cord involvement in a young boy responded with intravenous methylprednisolone

Authors: Sumita Saha Kanwar, Sumit Vats, Homdutt, Yashdeep Yadav

 DOI: https://dx.doi.org/10.18535/jmscr/v10i10.22

Abstract

Acute disseminated encephalomyelitis is an immune mediated demyelination of central nervous system. It is a monophasic clinical syndrome though recurrences have been reported in rare cases which can have widespread involvement in brain and spinal cord. This syndrome usually seen in children and young adults following infection or vaccination. ADEM is characterised pathologically by perivascular inflammation, demyelination and edema within the brain and spinal cord. Clinically manifesting in wide varieties from focal to multifocal neurological dysfunction. We describe a case of 16-years old boy who presented to us with altered sensorium following a seizure episode with history of fever with loose stool since 4 days. After two days during hospital stay he developed weakness in all four limbs with bladder involvement. MRI brain showed multifocal cortical and sub-cortical edema involving bilateral frontal, parietal, temporal regions with partial effacement of adjacent sulcal spaces. MRI Spine showed hyperintense signal on T2/STIR images involving cervical as well as dorsal cord particularly marked in lower cervical region extending from C4-C7 level with mild post contrast enhancement of involved parenchyma. He was diagnosed as ADEM and started on intravenous methylprednisolone for 5 days followed by oral prednisolone. He showed drastic improvement in weakness and at one month follow up he was normal clinically with resolution of radiological lesions.

Keywords: Acute disseminated encephalomyelitis–ADEM, Quadriparesis, Methylprednisolone.

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Corresponding Author

Homdutt

Senior Resident, Department of Medicine, Sanjay Gandhi Memorial Hospital, Mangolpuri, Delhi