Acute Disseminated Encephalomyelitis
| Autor: | E. Arena, A. Bartolini, N. Bisio, A. Murialdo, Paola Gazzola, F. Roncallo, Matilde Inglese |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Pathology
medicine.medical_specialty Radiological and Ultrasound Technology biology medicine.diagnostic_test business.industry Multiple sclerosis Central nervous system Magnetic resonance imaging medicine.disease Transverse myelitis Myelin basic protein Cerebrospinal fluid medicine.anatomical_structure Acute disseminated encephalomyelitis medicine biology.protein Radiology Nuclear Medicine and imaging Neurology (clinical) Demyelinating Disorder business |
| Zdroj: | Rivista di Neuroradiologia. 12:371-386 |
| ISSN: | 1120-9976 |
| DOI: | 10.1177/197140099901200302 |
| Popis: | Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system usually developing in close temporal relationship to an infective illness or vaccination. This paper presents clinical, cerebrospinal fluid and MRI findings in ADEM and discusses the role of the MRI in the distinction of ADEM and MS. We reviewed the medical records, cerebrospinal fluid (CSF) and MRI studies of six consecutive patients diagnosed as having ADEM during a three-year period. All patients had CSF, including electrophoresis for demonstration of oligoclonal bands, and MRI studies in the acute stage; five patients repeated these examinations in the subacute and chronic stages. Four patients had clinical evidence of a multifocal neurological syndrome. In the two other cases there was clinical evidence only of transverse myelitis. The CSF was abnormal in all cases and showed a mild increase in cell count and protein. IgG synthesis and myelin basic protein were present in three patients. MRI was abnormal in all six patients in the acute stage of the illness. In five cases there were some features of the distribution of the lesions which differed from those usually seen in MS. One showed extensive asymmetric bilateral changes; two had high signal lesions in the basal ganglia and thalamus; two demonstrated a tumour-like mass. One patient died one week after clinical onset and the pathologic findings showed an acute haemorrhagic leukoencephalitis. One patient demonstrated a recurrent MRI pattern of diffuse periventricular white matter lesions, after an abrupt end of corticosteroid treatment. Five patients demonstrated a marked decrease in the size and number of the lesions after steroid treatment; no new lesions were identified. The CNS white matter may be affected by inflammatory demyelinating disorders, including ADEM, that cause clinical diagnostic difficulty with MS. MS and ADEM may be indistinguishable in the acute phase. The clinical course of the disease together with the follow-up MRI will distinguish one entity from the other. Long-term follow-up disclosing newly appearing symptoms and lesions is against the diagnosis of ADEM, because this entity is typically a monophasic disease, unlike MS that usually has a releasing and relapsing course. |
| Databáze: | OpenAIRE |
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