Acute disseminated encephalomyelitis ADEM Review

Abstract

Acute disseminated encephalomyelitis ADEM is an inflammatory demyelinating disease of the central nervous system in studies of childhood ADEM In studies of childhood ADEM documented prodromal viral illness or vaccination history is present in approximately three quarters of the subjects Diagnosis is based on clinical and radiological findings Magnetic Resonance Imaging MRI of the brain is the investigation of choice and typically demonstrates white matter changes though grey matter may be involved Involvement of the deep grey matter particularly basal ganglia is more frequent In the absence of clinical recurrence new MRI lesions that appear beyond the first few months after ADEM may help in the early diagnosis of multiple sclerosis MS In contrast to MS ADEM is usually a monophasic disorder with favourable long term prognosis If relapses are thought to represent part of the same acute monophasic immune process the term ‘multiphasic disseminated encephalomyelitis’ MDEM is used High dose intravenous methylprednisolon has been found to be effective If that fails immunoglobulins plasmapheresis or cytotoxic drugs can be administered

Keywords

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Akut dissemine ensefalomiyelit ADEM Derleme

Öz

Akut dissemine ensefalomiyelit ADEM merkezi sinir sisteminin enflamatuar demiyelinizan bir hastalığıdır Çocukluk çağındaki ADEM çalışmalarında olguların yaklaşık dörtte üçünde öncesinde viral hastalık veya aşılanma öyküsü bulunur Tanı klinik ve radyolojik bulgulara dayanarak konulur Manyetik rezonans görüntüleme MR uygun bir incelemedir ve gri madde tutulumu olabilmekle birlikte özellikle ak madde değişikliklerini gösterir Derin gri maddenin özellikle bazal gangliyonların tutulumu daha sıktır Klinik yineleme olmaksızın ADEM sonrası ilk birkaç ayda yeni MR lezyonlarının saptanması multipl skleroz’un erken tanısında yardımcı olabilir Multipl skleroz’un tersine ADEM genellikle uzun süreli seyirin iyi olduğu monofazik bir hastalıktır Eğer relapsların aynı akut monofazik immün sürecin bir parçası olduğu düşünülüyorsa ‘multifazik dissemine ensefalomiyelit’ MDEM terimi kullanılır Yüksek doz intravenöz metilprednizolon tedavide etkin bulunmuştur Bununla başarı sağlanamazsa immunglobülinler plazmaferez veya sitotoksik ilaçlar kullanılabilir Anahtar Kelimeler: ADEM akut dissemine ensefalomiyelit çocukluk çağı MR

Anahtar Kelimeler

• ADEM, akut dissemine ensefalomiyelit, çocukluk çağı, MR

References

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