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:
Overview
ADEM has an abrupt onset and a monophasic course. Symptoms usually begin 1-3 weeks after infection or vaccination. Major symptoms include fever, headache, drowsiness, seizures and coma. Although initially the symptoms are usually mild, later in the course of the disease patients may even die, if they are not treated properly. Some patients recover completely, while others have permanent neurological impairments.
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): Diplopia, dysphagia, dysarthria, vertigo, hearing loss, loss of taste and smell
Meningism
References
- ↑ 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.