Sudden onset aphasic hemiplegia: an unusual manifestation of disseminated encephalomyelitis

The association of the sudden onset of aphasia with hemiplegia, hemisenosry defect, and facial palsy, with MRI evidence of white matter lesions, requires differentiation between multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). We have observed eight patients with such a syndr...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2004-06, Vol.106 (3), p.187-196
Main Authors: Brinar, Vesna V, Poser, Charles M, Basic, Silvije, Petelin, Zeljka
Format: Article
Language:English
Subjects:
Acute disseminated encephalomyelitis
Adolescent
Adult
Aphasia - diagnosis
Aphasia - etiology
Aphasic hemiplegia
Biological and medical sciences
Brain - pathology
Demyelinating Diseases - pathology
Diagnosis, Differential
Encephalomyelitis, Acute Disseminated - complications
Encephalomyelitis, Acute Disseminated - diagnosis
Female
Hemiplegia - diagnosis
Hemiplegia - etiology
Humans
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
MRI
Multiple sclerosis
Neurology
Neurosurgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
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Summary:The association of the sudden onset of aphasia with hemiplegia, hemisenosry defect, and facial palsy, with MRI evidence of white matter lesions, requires differentiation between multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). We have observed eight patients with such a syndrome, all of whom were originally diagnosed as multiple sclerosis, but who, on closer examination, turned out to be instances of disseminated encephalomyelitis. The patterns of demyelination seen in T2-weighted MRI are quite different in both conditions. In two of our patients, MRI reverted to normal after the treatment; in others, the images remained unchanged. A review of the reported cases of multiple sclerosis presenting with the acute onset of aphasia, reveals that the majority of them are, in reality, instances of acute disseminated encephalomyelitis with a much better prognosis. Most of these cases are monophasic and immunomodulatory treatment is inappropriate.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2004.02.015