Acute disseminated encephalomyelitis history and symptoms: Difference between revisions
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*[[Nausea]] and [[vomiting]] | *[[Nausea]] and [[vomiting]] | ||
*General [[neurological]] symptoms after 2-5 days<ref name="pmid27572859">{{cite journal| author=Pohl D, Alper G, Van Haren K, Kornberg AJ, Lucchinetti CF, Tenembaum S | display-authors=etal| title=Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome. | journal=Neurology | year= 2016 | volume= 87 | issue= 9 Suppl 2 | pages= S38-45 | pmid=27572859 | doi=10.1212/WNL.0000000000002825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27572859 }} </ref> | *General [[neurological]] symptoms after 2-5 days<ref name="pmid27572859">{{cite journal| author=Pohl D, Alper G, Van Haren K, Kornberg AJ, Lucchinetti CF, Tenembaum S | display-authors=etal| title=Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome. | journal=Neurology | year= 2016 | volume= 87 | issue= 9 Suppl 2 | pages= S38-45 | pmid=27572859 | doi=10.1212/WNL.0000000000002825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27572859 }} </ref> | ||
==== | ====Altered mental status==== | ||
*Features of [encephalopathy]] comprising changes in [[behaviour]] and [[consciousness]] (46-73% of [[pediatric]] [[patients]] and 20-56% of [[adult]] cases)<ref name="pmid23325908">{{cite journal| author=Marchioni E, Ravaglia S, Montomoli C, Tavazzi E, Minoli L, Baldanti F | display-authors=etal| title=Postinfectious neurologic syndromes: a prospective cohort study. | journal=Neurology | year= 2013 | volume= 80 | issue= 10 | pages= 882-9 | pmid=23325908 | doi=10.1212/WNL.0b013e3182840b95 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23325908 }} </ref> ranging in [[severity]] from [[lethargy]] to [[coma]]. Presence of [[encephalopathy]] differentiates [[pediatric]] [[ADEM]] from [[Multiple Sclerosis]]<ref name="pmid23572237">{{cite journal| author=Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC | display-authors=etal| title=International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. | journal=Mult Scler | year= 2013 | volume= 19 | issue= 10 | pages= 1261-7 | pmid=23572237 | doi=10.1177/1352458513484547 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23572237 }} </ref>. | *Features of [encephalopathy]] comprising changes in [[behaviour]] and [[consciousness]] (46-73% of [[pediatric]] [[patients]] and 20-56% of [[adult]] cases)<ref name="pmid23325908">{{cite journal| author=Marchioni E, Ravaglia S, Montomoli C, Tavazzi E, Minoli L, Baldanti F | display-authors=etal| title=Postinfectious neurologic syndromes: a prospective cohort study. | journal=Neurology | year= 2013 | volume= 80 | issue= 10 | pages= 882-9 | pmid=23325908 | doi=10.1212/WNL.0b013e3182840b95 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23325908 }} </ref> ranging in [[severity]] from [[lethargy]] to [[coma]]. Presence of [[encephalopathy]] differentiates [[pediatric]] [[ADEM]] from [[Multiple Sclerosis]]<ref name="pmid23572237">{{cite journal| author=Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC | display-authors=etal| title=International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. | journal=Mult Scler | year= 2013 | volume= 19 | issue= 10 | pages= 1261-7 | pmid=23572237 | doi=10.1177/1352458513484547 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23572237 }} </ref>. | ||
*[[Confusion]] | *[[Confusion]] | ||
*[[Psychosis]] | *[[Psychosis]] | ||
====Focal neurological symptoms==== | ====Focal neurological symptoms==== | ||
*Damage to [[occipital]] [[lobes]]: [[Homonymous]] [[visual]] [[field]] [[defects]], [[cortical]] [[blindness]] | *Damage to [[occipital]] [[lobes]]: [[Homonymous]] [[visual]] [[field]] [[defects]], [[cortical]] [[blindness]] | ||
Latest revision as of 10:13, 8 December 2022
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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.