[Acute disseminated encephalomyelitis in childhood. Report of 10 cases].
Mots clés
Abstrait
BACKGROUND
Acute disseminated encephalomyelitis (ADEM) is a postinfectious encephalitis that is usually preceded by an infectious disease or vaccination. The clinical presentation has a wide spectrum and complementary exams are none specific, except magnetic resonance imaging (MRI) findings showing multifocal white-matter lesions similar to those seen en multiple sclerosis.
METHODS
We report 10 children with the diagnosis of ADEM. We describe the clinical course and response to treatment.
RESULTS
The prodroms were fever in all cases except one. The most common neurological symptoms were consciousness impairment, headache and seizures. The cerebrospinal fluid examination was abnormal in 9 patients with positive serologic test to enterovirus in one of them. MRI showed hyperintense multifocal subcortical white-matter lesions on T2-mediated images. Treatment with steroids was given to 5 patients, steroids and immunoglobulins to one patient and symptomatic treatment to the rest. From the last group one patient relapsed and then received corticosteroid treatment. The follow up revealed a complete recovery in 6/7 patients that received steroids. Three patients have sequelae and of these, 2 received only symptomatic treatment.
CONCLUSIONS
The diagnosis of ADEM is based on clinical and radiologic features, once other entities have been excluded. At the moment of suspicious of ADEM a brain-spinal chord MRI should be done, seeing that TAC brings not much information at the beginning. The treatment with steroids seems to be the most effective and the prognosis good, specially in cases that respond rapidly to it.
