Abstract
Acute disseminated encephalomyelitis (ADEM) is an immunemediated inflammatory demyelinating disorder of the central nervous system. The white matter of the brain and spinal cord is predominantly affected although cortical gray matter, thalamus, and basal ganglia are often involved. A 24-year-old female presented with complaints of headache, instability and with a sixth cranial nerve paresis following an upper respiratory disease. Multiple ringlike contrast enhanced lesions were seen on magnetic resonance imaging (MRI) and the diagnosis was confirmed by a brain biopsy as ADEM. The patient’s complaints ceased and MRI lesions regressed after 1000mg methylprednisolone administration. Brain biopsy is rarely needed to diagnose ADEM and to exclude other infectious or malign processes. An experienced radiologist can usually make a diagnosis of ADEM correctly and during the follow-up period after medical treatment the resolution of MRI abnormalities in serial MRI scanning can also play a supportive role in diagnosing ADEM.
References
- 1. Bennetto L, Scolding N. Inflammatory/post-Infectious encephalomyelitis. J Neurol Neurosurg Psychiatr 2004;75:22-28. doi:10.1136/jnnp.2003.034256
- 2. Ketelslegers IA, Visser IE, Neuteboom RF, et al. Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in children. Mult Scler 2011;17:441-8. doi: 10.1177/1352458510390068.
- 3. Miller DH, Weinshenker BG, Filippi M, et al. Differential diagnosis of suspected multipl sclerosis. Mult Scler 2008;14:1157-74. doi:10.1177/1352458508096878
- 4. Tenembaum S, Chitnis T, Ness J, et al. Acute disseminated encephalomyelitis. Neurology 2007;68(16 Suppl 2):23-36.
- 5. Krupp LB, Banwell B, Tenebaum S. For the International Pediatric MS Study Group. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007;68:7-12.
- 6. Küker W, Ruff J, Gaertner S, Mehnert F, Mader I, Nägele T. Modern MRI tools for the characterization of acute demyelinating lesions: value of chemical shift and diffusionweighted imaging. Neuroradiology 2004;46:421–6. doi:10.1007/s00234-004-1203-5
- 7. de Seze J, Debouverie M, Zephir H, et al. Acute fulminant demyelinating disease: A descriptive study of 60 patients. Arch Neurol 2007;64:1426-32.
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Abstract
Akut dissemine ensefalomiyelit (ADEM), immün sistemin rol aldığı,
santral sinir sistemi (SSS)’nin demiyelinizasyonu ile seyreden
inflamatuar hastalığıdır. Bu hastalıkta beyin ve omuriliğin beyaz
cevheri ağırlıklı olarak etkilenmekle beraber kortikal gri cevher,
talamus ve basal ganglionların da tutulduğu görülür. Üst solunum
yolu enfeksiyonu sonrası gelişen baş ağrısı, dengesizlik ve 6. sinir
paralizisi ile kliniğimize başvuran kranial manyetik rezonans
görüntüleme (MRG) tetkikinde görülen halka tipi kontrast tutulumu
olan, yakınmaları ve lezyonları 1000 mg metilprednisolon ile belirgin
olarak gerileyen, beyin biyopsisi sonucu ADEM olduğu doğrulanan,
24 yaşındaki bir kadın olgu sunulmuştur. Beyin biyopsisi ADEM
tanısı için diğer enfeksiyöz ve malign süreçleri dışlamak amacı
ile nadiren gerekebilir. Diğer durumlarda tecrübeli bir radyolog
genellikle ADEM’i tanıyabilir veya tedavi sonrası yapılan takip
MRG’leri ile lezyonların gerilemesi de ADEM tanısında destekleyici
rol oynayabilir.
References
- 1. Bennetto L, Scolding N. Inflammatory/post-Infectious encephalomyelitis. J Neurol Neurosurg Psychiatr 2004;75:22-28. doi:10.1136/jnnp.2003.034256
- 2. Ketelslegers IA, Visser IE, Neuteboom RF, et al. Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in children. Mult Scler 2011;17:441-8. doi: 10.1177/1352458510390068.
- 3. Miller DH, Weinshenker BG, Filippi M, et al. Differential diagnosis of suspected multipl sclerosis. Mult Scler 2008;14:1157-74. doi:10.1177/1352458508096878
- 4. Tenembaum S, Chitnis T, Ness J, et al. Acute disseminated encephalomyelitis. Neurology 2007;68(16 Suppl 2):23-36.
- 5. Krupp LB, Banwell B, Tenebaum S. For the International Pediatric MS Study Group. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007;68:7-12.
- 6. Küker W, Ruff J, Gaertner S, Mehnert F, Mader I, Nägele T. Modern MRI tools for the characterization of acute demyelinating lesions: value of chemical shift and diffusionweighted imaging. Neuroradiology 2004;46:421–6. doi:10.1007/s00234-004-1203-5
- 7. de Seze J, Debouverie M, Zephir H, et al. Acute fulminant demyelinating disease: A descriptive study of 60 patients. Arch Neurol 2007;64:1426-32.
- 8. Callen DJ, Shroff MM, Branson HM, et al. Role of MRI in the differentiation of ADEM from MS in children. Neurology 2009;72:968-73.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | September 30, 2015 |
| Published in Issue | Year 2013 Volume: 26 Issue: 3 |
