Acute disseminated encephalomyelitis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Acute disseminated encephalomyelitis}} | {{Acute disseminated encephalomyelitis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Sujaya}} | ||
==Overview== | ==Overview== | ||
[[Antibodies]] like [[anti-MOG]] [[antibodies]] are found in the serum of [[patients]] suffering from [[ADEM]]. A [[lumbar]] [[puncture]] is also useful for evaluation of the changes in the [[Cerebrospinal fluid]] ([[CSF]]). | |||
== Laboratory Findings == | ==Laboratory Findings== | ||
* | ===Antibodies=== | ||
* CSF lymphocytic pleocytosis | *High titers of [[anti-MOG]] [[antibodies]] are found in the [[acute]] phase, which tends to decrease and eventually disappear over time<ref name="pmid25121570">{{cite journal| author=Baumann M, Sahin K, Lechner C, Hennes EM, Schanda K, Mader S | display-authors=etal| title=Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein. | journal=J Neurol Neurosurg Psychiatry | year= 2015 | volume= 86 | issue= 3 | pages= 265-72 | pmid=25121570 | doi=10.1136/jnnp-2014-308346 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25121570 }} </ref><ref name="pmid21169067">{{cite journal| author=Di Pauli F, Mader S, Rostasy K, Schanda K, Bajer-Kornek B, Ehling R | display-authors=etal| title=Temporal dynamics of anti-MOG antibodies in CNS demyelinating diseases. | journal=Clin Immunol | year= 2011 | volume= 138 | issue= 3 | pages= 247-54 | pmid=21169067 | doi=10.1016/j.clim.2010.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21169067 }} </ref>. | ||
* | *[[IgG]] [[autoantibodies]] targeting [[myelin]] [[autoantigens]] such as [[MBP]], [[alpha-B crystalline]] and [[PLP]] may help distinguish [[ADEM]] from [[MS]]<ref name="pmid23612879">{{cite journal| author=Van Haren K, Tomooka BH, Kidd BA, Banwell B, Bar-Or A, Chitnis T | display-authors=etal| title=Serum autoantibodies to myelin peptides distinguish acute disseminated encephalomyelitis from relapsing-remitting multiple sclerosis. | journal=Mult Scler | year= 2013 | volume= 19 | issue= 13 | pages= 1726-33 | pmid=23612879 | doi=10.1177/1352458513485653 | pmc=4411183 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23612879 }} </ref>. | ||
*Presence of serum [[anti-AQP4-IgG]] [[antibodies]] rules out a [[diagnosis]] of [[ADEM]]. | |||
===CSF studies=== | |||
*Non-specific [[lymphocytic]] [[pleocytosis]] and elevated [[albumin]] levels<ref name="pmid11376180">{{cite journal| author=Schwarz S, Mohr A, Knauth M, Wildemann B, Storch-Hagenlocher B| title=Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients. | journal=Neurology | year= 2001 | volume= 56 | issue= 10 | pages= 1313-8 | pmid=11376180 | doi=10.1212/wnl.56.10.1313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11376180 }} </ref> | |||
*Transient <ref name="pmid10521553">{{cite journal| author=O'Riordan JI, Gomez-Anson B, Moseley IF, Miller DH| title=Long term MRI follow-up of patients with post infectious encephalomyelitis: evidence for a monophasic disease. | journal=J Neurol Sci | year= 1999 | volume= 167 | issue= 2 | pages= 132-6 | pmid=10521553 | doi=10.1016/s0022-510x(99)00160-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10521553 }} </ref> [[oligoclonal]] banding with a [[median]] [[frequency]] of 12.5% (range 0-29%)<ref name="pmid12887662">{{cite journal| author=Gupte G, Stonehouse M, Wassmer E, Coad NA, Whitehouse WP| title=Acute disseminated encephalomyelitis: a review of 18 cases in childhood. | journal=J Paediatr Child Health | year= 2003 | volume= 39 | issue= 5 | pages= 336-42 | pmid=12887662 | doi=10.1046/j.1440-1754.2003.00154.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12887662 }} </ref> in children and higher in the adult cases (37.5-58%)<ref name="pmid10521553">{{cite journal| author=O'Riordan JI, Gomez-Anson B, Moseley IF, Miller DH| title=Long term MRI follow-up of patients with post infectious encephalomyelitis: evidence for a monophasic disease. | journal=J Neurol Sci | year= 1999 | volume= 167 | issue= 2 | pages= 132-6 | pmid=10521553 | doi=10.1016/s0022-510x(99)00160-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10521553 }} </ref>. | |||
*Identification of the [[pathogen]] by specific [[cell-culture]] techniques or [[PCR]]<ref name="pmid12583615">{{cite journal| author=Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M| title=Epstein-Barr virus infections of the central nervous system. | journal=Intern Med | year= 2003 | volume= 42 | issue= 1 | pages= 33-40 | pmid=12583615 | doi=10.2169/internalmedicine.42.33 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12583615 }} </ref><ref name="pmid11545490">{{cite journal| author=Riedel K, Kempf VA, Bechtold A, Klimmer M| title=Acute disseminated encephalomyelitis (ADEM) due to Mycoplasma pneumoniae infection in an adolescent. | journal=Infection | year= 2001 | volume= 29 | issue= 4 | pages= 240-2 | pmid=11545490 | doi=10.1007/s15010-001-1173-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11545490 }} </ref>. The high [[prevalence]] of [[neurtropic]] [[viruses]] in the general population may lead to a spurious [[PCR]] result, making it difficult to prove a causal relation. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
{{WS}} | |||
{{WH}} | |||
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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
Antibodies like anti-MOG antibodies are found in the serum of patients suffering from ADEM. A lumbar puncture is also useful for evaluation of the changes in the Cerebrospinal fluid (CSF).
Laboratory Findings
Antibodies
- High titers of anti-MOG antibodies are found in the acute phase, which tends to decrease and eventually disappear over time[1][2].
- IgG autoantibodies targeting myelin autoantigens such as MBP, alpha-B crystalline and PLP may help distinguish ADEM from MS[3].
- Presence of serum anti-AQP4-IgG antibodies rules out a diagnosis of ADEM.
CSF studies
- Non-specific lymphocytic pleocytosis and elevated albumin levels[4]
- Transient [5] oligoclonal banding with a median frequency of 12.5% (range 0-29%)[6] in children and higher in the adult cases (37.5-58%)[5].
- Identification of the pathogen by specific cell-culture techniques or PCR[7][8]. The high prevalence of neurtropic viruses in the general population may lead to a spurious PCR result, making it difficult to prove a causal relation.
References
- ↑ Baumann M, Sahin K, Lechner C, Hennes EM, Schanda K, Mader S; et al. (2015). "Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein". J Neurol Neurosurg Psychiatry. 86 (3): 265–72. doi:10.1136/jnnp-2014-308346. PMID 25121570.
- ↑ Di Pauli F, Mader S, Rostasy K, Schanda K, Bajer-Kornek B, Ehling R; et al. (2011). "Temporal dynamics of anti-MOG antibodies in CNS demyelinating diseases". Clin Immunol. 138 (3): 247–54. doi:10.1016/j.clim.2010.11.013. PMID 21169067.
- ↑ Van Haren K, Tomooka BH, Kidd BA, Banwell B, Bar-Or A, Chitnis T; et al. (2013). "Serum autoantibodies to myelin peptides distinguish acute disseminated encephalomyelitis from relapsing-remitting multiple sclerosis". Mult Scler. 19 (13): 1726–33. doi:10.1177/1352458513485653. PMC 4411183. PMID 23612879.
- ↑ Schwarz S, Mohr A, Knauth M, Wildemann B, Storch-Hagenlocher B (2001). "Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients". Neurology. 56 (10): 1313–8. doi:10.1212/wnl.56.10.1313. PMID 11376180.
- ↑ 5.0 5.1 O'Riordan JI, Gomez-Anson B, Moseley IF, Miller DH (1999). "Long term MRI follow-up of patients with post infectious encephalomyelitis: evidence for a monophasic disease". J Neurol Sci. 167 (2): 132–6. doi:10.1016/s0022-510x(99)00160-4. PMID 10521553.
- ↑ Gupte G, Stonehouse M, Wassmer E, Coad NA, Whitehouse WP (2003). "Acute disseminated encephalomyelitis: a review of 18 cases in childhood". J Paediatr Child Health. 39 (5): 336–42. doi:10.1046/j.1440-1754.2003.00154.x. PMID 12887662.
- ↑ Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M (2003). "Epstein-Barr virus infections of the central nervous system". Intern Med. 42 (1): 33–40. doi:10.2169/internalmedicine.42.33. PMID 12583615.
- ↑ Riedel K, Kempf VA, Bechtold A, Klimmer M (2001). "Acute disseminated encephalomyelitis (ADEM) due to Mycoplasma pneumoniae infection in an adolescent". Infection. 29 (4): 240–2. doi:10.1007/s15010-001-1173-z. PMID 11545490.