Acute disseminated encephalomyelitis following varicella‐zoster virus infection: Case report of effective treated both in clinical symptom and neuroimaging

• Published in: Brain and behavior 2019-09, Vol.9 (9), p.e01374-n/a
• Main Authors: Wang, Qi, Cai, Li‐Na, Wang, Xiang‐Qing
• Format: Article
• Language: English
• Subjects: acute disseminated encephalomyelitis; Adolescent; Anti-Inflammatory Agents - therapeutic use; Antiviral Agents - therapeutic use; Brain - diagnostic imaging; Brain - pathology; Brain - virology; Case reports; central nervous system; Chicken pox; Encephalomyelitis; Encephalomyelitis, Acute Disseminated - cerebrospinal fluid; Encephalomyelitis, Acute Disseminated - complications; Encephalomyelitis, Acute Disseminated - diagnostic imaging; Encephalomyelitis, Acute Disseminated - drug therapy; Female; Ganciclovir - therapeutic use; Humans; Immunization; Immunoglobulins; Infections; Magnetic Resonance Imaging - methods; Methods; Methylprednisolone - therapeutic use; Multiple sclerosis; Nervous system; Neuroimaging; Neuroimaging - methods; NMR; Nuclear magnetic resonance; Patients; Proteins; Retention; Spinal cord; Spinal Cord - diagnostic imaging; Spinal Cord - virology; Steroids; Treatment Outcome; Varicella Zoster Virus Infection - cerebrospinal fluid; Varicella Zoster Virus Infection - complications; Varicella Zoster Virus Infection - diagnosis; Varicella Zoster Virus Infection - drug therapy; Viruses
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.1374

Introduction Acute disseminated encephalomyelitis (ADEM) is an idiopathic inflammatory demyelinating disorder of the central nervous system (CNS). Early treatment is the key for neurological recovery. Methods A case of ADEM associated with varicella‐zoster virus infection was presented, in which magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) examinations were included. Results Magnetic resonance imaging of the brain revealed multiple hyperintense lesions at the subcortical level on fluid‐attenuated inversion recovery (FLAIR), and MRI of the spinal cord revealed longitudinally segmented hyperintense lesions at the spinal cord on T2‐weighted images. The patient was treated with methylprednisolone and gancyclovir, and had a favorable recovery. Subsequent MRI of the brain and cervical cord showed the previous abnormal hyperintensities had markedly disappeared. Conclusion A rare case of ADEM with longitudinal segmented hyperintense lesions at the spinal cord on T2‐weighted images was presented. Excellent response to ADEM treatment with high‐dose steroids was reported resulting in a remarkable neurological recovery. A long‐term follow‐up is needed for prognosis. Acute disseminated encephalomyelitis (ADEM) rarely presents longitudinally with segmented hyperintense lesions at the spinal cord on T2‐weighted images. With limited case reports, the prognosis is unknown. Excellent response to ADEM treatment with high‐dose steroids was reported resulting in a remarkable neurological recovery. A long‐term follow‐up is needed for prognosis.