Acute disseminated encephalomyelitis in children - clinical and MRI decision making in the emergency department
| Autor: | Ayelet Rimon, Rotem Orbach, Orly Bisker Kassif, Miguel Glatstein, Dennis Scolnik |
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| Rok vydání: | 2019 |
| Předmět: |
Neurological signs
Male Pediatrics medicine.medical_specialty Time Factors Adolescent Fever Prednisolone Encephalopathy Decision Making Immunoglobulins Disease 03 medical and health sciences 0302 clinical medicine Seizures medicine Humans Child Retrospective Studies Neurologic Examination medicine.diagnostic_test business.industry Encephalomyelitis Acute Disseminated Brain Infant 030208 emergency & critical care medicine Magnetic resonance imaging General Medicine Emergency department medicine.disease Magnetic Resonance Imaging Child Preschool Acute disseminated encephalomyelitis Emergency Medicine Female Presentation (obstetrics) business Emergency Service Hospital Rare disease |
| Zdroj: | The American journal of emergency medicine. 37(11) |
| ISSN: | 1532-8171 |
| Popis: | Background Acute disseminated encephalomyelitis (ADEM) is an uncommon, treatable, primarily pediatric, immune-mediated disease. Diagnosis of ADEM requires two essential elements: typical clinical presentation and magnetic resonance imaging (MRI) findings. The aim of this study was to evaluate how clinical findings in the initial emergency department (ED) presentation influenced the timing of MRI. Methods A retrospective chart review was conducted of children diagnosed with ADEM, over a 12-year period, in a tertiary care pediatric center. Clinical presentation at ED admission was recorded and patients who underwent an MRI as part of their ED evaluation (early MRI) with those who had MRI performed during ward hospitalization (late MRI) were compared. Results 30 patients were diagnosed with ADEM during the study period. Encephalopathy and polyfocal neurological signs were described in 80% and 50% of patients ED charts, respectively. Seven patients underwent early MRI and polyfocal neurological signs were more common in this group (p = 0.006). Fever was more common in the late MRI group (p = 0.02). Following diagnosis, all patients were treated with immune-modulation therapy, improved clinically, and were discharged. Conclusion 20% of ADEM patients were not encephalopathic at ED presentation. Polyfocal neurological signs and absence of fever at ED presentation were related to earlier MRI utilization and thus earlier diagnosis and treatment. Familiarity with the ADEM constellation of signs, and a high index of suspicion, may help the ED clinician in early diagnosis and treatment of this rare disease. |
| Databáze: | OpenAIRE |
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