 10 YEAR OLD WITH ADEM |
| Contributed by:
Faculty and residents Children's Hospital, Radiologist, Children's Health System, Birmingham, Alabama., USA. |
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Patient: 10 year 2 month old female |
| History: 10 year 2 month old female: presents a two day history of clumsiness about her lower extremities recently progressing to difficulty with walking. Pertinent past medical history includes symptoms of a gastroenteritis approximately two weeks prior to the onset of new symptoms. |
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| Findings: Inital CT findings include subtle hypodensity of the subcortical white matter including the centrum semiovale and corona radiata. Basilar cisterns remained intact. MRI revealed market T2 FLAIR hyperintensity throughout the subcortical white matter. T1WI sequences demonstrated decreased signal throughout the same regions. Follow up CT one day after initial presentation demonstrated marked blurring of the gray-white junction with effacement and loss of the basilar cisterns concerning for herniation syndrome. |
| Diagnosis: ADEM |
| Discussion: Autoimmute mediated demyelination 10-14 days following vaccination or viral infection. Peak incidence in 3-5 year old group. Affects the brain and spinal cord typically. Rarely peripheral nerves. Variable prognosis: Mortality 10-30%, 50-60% recovery completely in one month Imagining: Best clue: Multifocal hyperintense lesions on T2WI and FLAIR within the deep cerebral white matter and basal ganglia. Less regular in shape than those lesions typical of multiple sclerosis. T1WI demonstrates hypointense lesions with minimal mass effect. CT: NECT, 40% demonstrate normal exam on initial scan. Typical findings are multifocal, low density, subcortical white matter changes. CECT demonstrates mild to moderate enhancement of lesions. Can look identical to MS. ADEM is typically monophasic. MS is relapsing-remitting course with lesions seperated by space and time. Histiocytosis syndromes typcially have much more discrete lesions. Posterior reversible encephalopathy syndrome demonstrates white matter edema induced by hypertension, siezures, and immunosupressants. Typically within the occipital white matter. Resolves with treatment or reduction of the offending medication.
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| References: Dale RC (April 2003). "Acute disseminated encephalomyelitis". Semin Pediatr Infect Dis 14 (2): 90–5. Garg RK (January 2003). "Acute disseminated encephalomyelitis". Postgrad Med J 79 (927): 11–7. Jones CT (November 2003). "Childhood autoimmune neurologic diseases of the central nervous system". Neurol Clin 21 (4): 745–64. |
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| Additional Details:
Case Number: 32193895 The reader is fully responsible for confirming the accuracy of this content. |
