Case Report

Acute Disseminated Encephalomyelitis. Case Presentation

Authors: Yusdelis Ortiz Licea, Dunia Hernández Carulla, Roxana Montes Licea

DOI: 10.33425/3070-3948.1009

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Abstract

Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating disorder of the central nervous system (CNS) with a predilection in early childhood. It is characterized by encephalopathy, multifocal neurological symptoms, and imaging evidence of central demyelination. It has an incidence of 0,4–0,6 per 100 000 children/year worldwide, with a predominance in males.

Objective: To describe the clinical case of an adolescent with acute disseminated encephalitis.

Clinical Case: A 12-year-old adolescent presented to the emergency department with an acute episode of severe headache, vomiting, unsteady gait, diplopia, and bradypsychia, preceded by a nonspecific fever. Physical examination revealed ataxic gait, dysmetria, and right cranial nerve paralysis of the third and sixth nerves. Fundoscopy revealed effacement of papillary margins with marked venous tortuosity and peripapillary hemorrhages. Brain MRI revealed edematous, hypointense lesions on T1-weighted images and hyperintense lesions on T2-weighted images located in the pons, cerebellar peduncle, part of the right cerebellar hemisphere, right occipital lobe, left parietal lobe, and the largest lesion in the right frontoparietal lobe. ADEM was diagnosed, and treatment with methylprednisolone at a dose of 30 mg/ kg/day for 5 days was initiated, with symptom remission.

Conclusion: ADEM constitutes a diagnostic dilemma. It should always be considered in patients with CNS pathology and a history of immunizations and infections in the previous 2 weeks. Despite its dramatic clinical and radiological presentation, it shows good recovery with appropriate treatment.

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