Increased Intracranial Pressure in Acute Disseminated Encephalomyelitis (original) (raw)
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Pediatric Acute Disseminated Encephalomyelitis : Difficulties in Predicting the Outcome
Introduction: Acute disseminated encephalomyelitis is a central nervous system demyelinating disease characterised by encephalopathy and multifocal neurological symptoms. This study intends to characterise a series of 15 hospitalised children diagnosed with acute disseminated encephalomyelitis and to identify the outcome prediction factors. Methods: Retrospective observational study about a series of children hospitalised with the diagnosis of acute disseminated encephalomyelitis, admitted between 1993 and 2015, through data collected from patient medical records. Microsoft Office Excel ® and R 3.1.2 ® software were used for the data analysis and statistical analysis, respectively. The statistical analysis included logistic regression models, log-ratio test, t-test and odds ratio with a 95% confidence interval. Results: Most of the patients had a polysymptomatic presentation, mainly with encephalopathy, pyramidal motor signs, cranial neuropathies and ataxia. Serological and microbiological findings were positive in 53% of the children. Fourteen children were treated with glucocorticoids and four with intravenous immunoglobulin as rescue therapy. One patient developed multiphasic disseminated encephalomyelitis. All the patients recovered from the acute event, with a 100% survival rate. In the follow up period, neurologic impairment was present in 53% of the patients, and was considered moderate in more than half of them. Age at the time of diagnosis, gender, preceding symptoms, positive serologic and microbiological findings, fever at admission, length of hospital stay and altered electroencephalogram were analysed, without direct interference in the prognosis. Diagnosis and therapy institution delay did not seem to affect the clinical recovery. Discussion: It was not possible to find factors that can predict the outcome in this case series. Although future studies with other paediatric patients with acute disseminated encephalomyelitis are necessary in order to better identify outcome prediction factors, a long-term follow-up should be performed to document recovery and confirm the diagnosis of acute disseminated encephalomyelitis.
Iranian Journal of Child Neurology, 2019
Objectives We aimed to study the precipitating factors, demographic data, clinical and radiological manifestations, electroencephalography and laboratory findings, as well as association with infections, immunization and incidence of relapse of acute disseminated encephalomyelitis (ADEM) in children admitted to Mofid Children Hospital, Tehran, Iran from Mar 2013 to Mar 2016. Materials & Methods A 3-yr retrospective review of 29 children with definite final diagnosis of ADEM in Mofid Hospital in Tehran, Iran was performed. The diagnosis was based on specified criteria, including a presumed acute demyelinating process with no history of unexplained neurological symptoms and at least one demyelinating lesion shown on magnetic resonance imaging without evidence of previous destructive white matter lesions. Results Overall, 29 children diagnosed as ADEM were studied in terms of demographic characteristics, clinical manifestations and laboratory findings in two groups according to their r...
Raised intracranial pressure in acute viral encephalitis
Clinical Neurology and Neurosurgery, 2009
There is paucity of data evaluating intracranial pressure (ICP) rise and its management in acute viral encephalitis (AVE). Noteworthy is the current prevalence of unselective and broad utilization of ICP lowering therapies in clinical practice. Trends in current management of ICP in AVE emanate from data extrapolated from results of studies done on cerebral malaria, bacterial meningitis, stroke, and brain trauma patients. In this article we review (1) clinical correlates of raised ICP, (2) pathology, (3) imaging data, (4) monitoring, and, (5) treatment, of raised ICP in AVE. ICP monitoring is a useful adjunct to management of raised ICP in adults, becoming especially important in Herpes encephalitis and encephalitis with status epilepticus. In children it substantially influences clinical management and continuous monitoring of mean blood pressure (MBP) and ICP can aid in early diagnosis and treatment when cerebral perfusion pressure (CPP) falls below critical levels. Current evidence suggests that the pathomechanisms that contribute to the development of raised intracranial pressure vary in viral encephalitides of different etiology, and different forms of cerebral edema result at different times in the course of the illness, thus creating a need for studies to investigate the usefulness of various edema-specific ICP lowering modalities in AVE.
Acute disseminated encephalomyelitis in children: one medical center experience
Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi
Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of the central nervous system. The experience in children is limited. We retrospectively reviewed our experience with 20 ADEM patients (10 females, 10 males) with age of onset before 18 years old in Taiwan to clarify the clinical manifestations, neuroimaging findings, and the relationship between ADEM and multiple sclerosis (MS). The age at onset ranged from 4 months to 15 years. Seventeen (85%) children had a recent infectious prodrome. Children presented most often with acute consciousness disturbance (70%) and motor deficits (55%). Seizures occurred in 10 (50%), but only one child developed epilepsy in follow-up. Brain magnetic resonance imaging (MRI) evaluations done in all patients revealed multifocal lesions, mainly in subcortical white matter (80%), brainstem (65%), basal ganglia (55%), cerebellum (45%), thalamus (40%), and periventricular white matter (35%). Spinal cord MRI was performed...
Boletín de la Asociación Médica de Puerto Rico, 2013
Acute disseminated encephalomyelitis (ADEM) is an inflammatory monophasic condition of the central nervous system. We aimed to recognize the clinical, neuroradiologic, and cerebral spinal fluid features present during the initial event of ADEM in children, and the possible predictive relapse factors that may lead to recurrent or multiphasic ADEM using the proposed definitions of the International Pediatric Multiple Sclerosis Study Group published in 2007. A retrospective observational study was conducted at the University Pediatric Hospital. Thirteen subjects were included in the study. Seven children had mild encephalopathy as first event. Eleven patients had supratentorial and infratentorial involvement, and in six of the patients the lesions were greater than one cm. In our study seven of the thirteen patients with ADEM went on to relapse. Six of these patients developed multiphasic ADEM while one patient developed recurrent ADEM. Our results found no clear association between th...
Acute Disseminated Encephalomyelitis in Children
PEDIATRICS, 2002
Objective. To describe the epidemiologic, clinical, neuroimaging, and laboratory features; treatment; and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM).
Outcome of children with acute disseminated encephalomyelitis in a tertiary care center in India
The Turkish journal of pediatrics
Acute disseminated encephalomyelitis (ADEM) is an immune-mediated disease of the brain that follows viral infection or vaccination, or even appears spontaneously. The objective of the study was to evaluate the clinical, neuroimaging and laboratory profiles of children with ADEM. Seventeen children admitted to the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, whose cases were consistent with the diagnosis of ADEM, were included. Their clinical and neuroimaging profiles and outcomes were studied. The most common presenting features were fever (71%), altered sensorium (59%) and headache and convulsions (41%). Brain MRI identified lesions in subcortical white matter (75%) and periventricular white matter (38%). Most patients were treated with corticosteroids. A favorable outcome was seen in 88% of patients. Although 59% of patients had neurologic sequelae at discharge, only one patient had a major neurological deficit at follow-up. Prognosis for survival and o...
Pediatrics, 2005
Objectives. To describe our experience with acute disseminated encephalomyelitis (ADEM), focusing on (1) the relationship between clinical course and MRI findings and (2) the response to plasmapheresis in a subgroup of patients. Methods. A retrospective record review was conducted of 13 children who were admitted as inpatients with the diagnosis of ADEM during the period 1998-2003. Results. Diagnosis was established by clinical signs and symptoms, cerebrospinal fluid changes and multifocal involvement of deep gray and white matter based on MRI. Initial therapy was high-dose methylprednisolone and intravenous immunoglobulin in 12 patients. One child improved spontaneously. Six of 12 children did not improve with corticosteroid treatment. All 6 had an acute progressive course neurologically, and 5 of them also showed a delay in the onset of neuroimaging changes, eventually developing lesions in the deep gray matter and brainstem. This latter group received 5 sessions of plasmapheresis and recovered over the course of several months with varying degrees of residual neurologic deficits. Conclusions. Presentation of ADEM with delayed development of MRI lesions in deep gray matter and brainstem may herald a prolonged clinical course and lack of response to glucocorticoid therapy. Plasmapheresis might be an effective therapeutic intervention in these patients. The role of plasmapheresis versus corticosteroids and intravenous immunoglobulin as a primary treatment of ADEM needs to be investigated further.
Evaluation of the cases with acute disseminated encephalomyelitis
The Indian Journal of Pediatrics, 2009
All of the cases were reevaluated with systemic and neurological examinations, serologic tests, cerebrospinal fluid investigations, magnetic resonance imaging. Age ranged between 2.5 and 16 years. Five of the cases had initial infections. Patients presented most often with motor deficits (75%), secondly with loss of consciousness (33%), and seizures (33%). Spinal fluid abnormalities occurred in 41.6%. Cranial, and spinal magnetic resonance imaging (MRI) revealed hyperintense signal changes mainly in basal ganglia and thalamus (58%), cortical and subcortical areas (33) in T2 weighted images. Myelitis was determined in two cases. Six patients were treated with steroid, and 3 were treated with intravenous immunoglobulin. Ten patients recovered completely. We observed relapse in one case and recurrence in two cases. These cases responded well to high dose intravenous prednisolone followed by oral prednisolone for 6 months. [Indian J Pediatr 2009; 76 (5) : 547-550]
Acute disseminated encephalomyelitis: an evaluation of 15 cases in childhood
PubMed, 2013
To describe our experience with acute disseminated encephalomyelitis (ADEM) and the relationships between the clinical course, magnetic resonance imaging (MRI) findings and treatment, a retrospective record review was conducted of 15 children who were admitted with the diagnosis of ADEM during the period 2004-2010. Their ages ranged between 2 and 13 years. Patients presented most often with ataxia (53.3%) and secondly with weakness and headache (46.6%). Myelitis was determined in two patients. Five patients were treated with high-dose intravenous (IV) methylprednisolone followed by oral prednisolone, seven patients were treated with oral prednisolone, one patient was treated with plasmapheresis with IV immunoglobulin (Ig), and one patient was treated with IVIg. We observed recurrence in one patient. ADEM is a demyelinating disorder that is being diagnosed increasingly more as MRI studies are performed more frequently in patients with acute encephalopathy. Early diagnosis and therapy might improve the outcome.