Acute disseminated encephalomyelitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]
Overview
Classic ADEM is monophasic, with a history of usually a preceding illness or less commonly, a vaccination. It is characterised by an acute onset of focal neurologic symptoms, often with rapid deterioration of consciouness, after a variable latent period of several days to few months.
History
Classic ADEM is monophasic, with a history of usually a preceding illness or less commonly, a vaccination. It is characterised by an acute onset of focal neurologic symptoms, often with rapid deterioration of consciouness, after a variable latent period of several days to few months.
Symptoms
Typical
Prodromal symptoms
- Identical in adults and children
- Headache
- Fever, malaise
- Irritability
- Nausea and vomiting
- General neurological symptoms after 2-5 days[1]
Altered mental status
- Features of [encephalopathy]] comprising changes in behaviour and consciousness (46-73% of pediatric patients and 20-56% of adult cases)[2] ranging in severity from lethargy to coma. Presence of encephalopathy differentiates pediatric ADEM from Multiple Sclerosis[3].
- Confusion
- Psychosis
Focal neurological symptoms
- Damage to occipital lobes: Homonymous visual field defects, cortical blindness
- Agraphia, aphasia, alexia, acalculia
- Sensory symptoms: Astereognosis ,agraphesthesia, loss of proprioception, vibration and temperature sensation
- Brainstem involvement (carries a poorer prognosis and a higher risk of fulminant disease course[4]): Diplopia, dysphagia, dysarthria, vertigo, hearing loss, loss of taste and smell[1]
Meningism
Caused by lymphocytic infiltration of the meninges in 26-31% of cases
Atypical symptoms
Other conditions should be excluded in the presence of the following atypical features of ADEM[1]:
- Progressive onset
- Persistent headache
- Stroke-like events
- Recurrent seizures (predominant in pediatric cases)
- Neuropsychiatric symptoms
References
- ↑ 1.0 1.1 1.2 Pohl D, Alper G, Van Haren K, Kornberg AJ, Lucchinetti CF, Tenembaum S; et al. (2016). "Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome". Neurology. 87 (9 Suppl 2): S38–45. doi:10.1212/WNL.0000000000002825. PMID 27572859.
- ↑ Marchioni E, Ravaglia S, Montomoli C, Tavazzi E, Minoli L, Baldanti F; et al. (2013). "Postinfectious neurologic syndromes: a prospective cohort study". Neurology. 80 (10): 882–9. doi:10.1212/WNL.0b013e3182840b95. PMID 23325908.
- ↑ Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC; et al. (2013). "International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions". Mult Scler. 19 (10): 1261–7. doi:10.1177/1352458513484547. PMID 23572237.
- ↑ Tenembaum SN (2008). "Disseminated encephalomyelitis in children". Clin Neurol Neurosurg. 110 (9): 928–38. doi:10.1016/j.clineuro.2007.12.018. PMC 7116932 Check
|pmc=value (help). PMID 18272282.