Acute disseminated encephalomyelitis in childhood: Single center experience

Abstract

Objective: To describe the epidemiologic, clinical, neuroimaging, and laboratory features; treatment; and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM). Methods: Clinical features, laboratory and radiological findings of 14 patients with the diagnosis of ADEM were recorded in 2004-2010 in the range of 6-year follow-up time period in Pediatric Neurology Department of Selçuk University. Results: Ten patients were boys and four were girls. Ten patients presented either in winter or in spring. The majority of patients (64.2%) had as history of acute febrile illness. Patients presented most often with gait disturbances (71.4%) and secondly with altered consciousness (57%). Despite rigorous microbiologic testing, a definite microbiologic diagnosis was established only in four patients. Brain magnetic resonance imaging (MRI) identified lesions in the cortex and, or in subcortical white matter, especially in the frontal (57%) and temporal (42%) regions. Ten patients were treated with corticosteroids, and four were treated with intravenous immunoglobulin. Ganciclovir and clarithromycin were administered in patients with Epstein-Barr virus and mycoplasma according to the serology. In 13 patients, all neurologic signs and symptoms resolved after treatment. Conclusion: The present series demonstrates that acute disseminated encephalomyelitis in children occurs predominantly in winter and spring and often follows an upper respiratory tract illness.

Keywords

• Acute disseminated encaphalomyelitis, childhood, MRI

Çocukluk çağında akut dissemine ensefalomiyelit: Tek merkez deneyimi

Abstract

Amaç: Çocuklarda akut dissemine ensefalomyelitin (ADEM) epidemiyolojik, klinik, nöro-görüntüleme ve laboratuvar bulguları ile tedavi ve sonuçlarının araştırılması amaçlandı. Yöntemler: Selçuk Üniversitesi Pediatrik Nöroloji Bilim Dalında Ocak 2004-Ocak 2010 aralığındaki altı yıllık zaman diliminde ADEM tanısı ile takip edilen on dört hastanın öyküleri, klinik özellikleri, laboratuar ve radyolojik bulguları kaydedildi. Bulgular: Olgularımızın onu erkek, dördü kız idi. On hastanın başvuru mevsimi kış ya da ilkbahar ayı idi. Hastaların büyük kısmında (%64,2) geçirilmiş akut ateşli hastalık öyküsü vardı. En sık görülen başvuru semptomları yürüme bozukluğu (%71,4) ve bilinç durumunda değişiklik (%57) idi. Detaylı laboratuvar incelemelerine rağmen sadece dört hastada mikrobiyolojik ajan gösterilebildi. Kranial magnetik rezonans görüntülemede (MRG) kortikal ve subkortikal beyaz cevher tutulumu özellikle frontal (%57) ve temporal (%42) tutulum saptandı. On hasta kortikosteroid, 4 hasta ise intravenöz immunglobülin tedavisi aldı. Ebstein-Barr virüs ve mikoplazma serolojisi pozitif olan hastalara gansiklovir ve klaritromisin tedavisi verildi. Onüç hastada tedavi ile nörolojik şikayet ve bulgular tamamen kayboldu. Sonuç: Bu seride çocuklarda ADEM\'in esas olarak kış ve ilkbahar aylarında ve bir üst solunum yolu enfeksiyonunu takiben ortaya çıktığı bulundu.

Keywords

• Akut dissemine ensefalomiyelit, çocukluk çağı, MRG

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