Acute disseminated encephalomyelitis in adults: a reappraisal of clinical, CSF, EEG, and MRI findings

• Published in: Journal of neurology 2002-03, Vol.249 (3), p.320-329
• Main Authors: HÖLLINGER, Peter, STURZENEGGER, Matthias, MATHIS, Johannes, SCHROTH, Gerhard, HESS, Christian W
• Format: Article
• Language: English
• Subjects: Adult; Adults; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Central Nervous System Infections - blood; Central Nervous System Infections - complications; Central Nervous System Infections - diagnosis; Cerebrospinal fluid; Cognitive ability; Diagnosis; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; EEG; Electroencephalography; Electromyography; Encephalomyelitis; Encephalomyelitis, Acute Disseminated - cerebrospinal fluid; Encephalomyelitis, Acute Disseminated - diagnosis; Encephalomyelitis, Acute Disseminated - pathology; Female; Gastrointestinal Diseases - complications; Humans; Influenza, Human - complications; Magnetic Resonance Imaging; Male; Medical sciences; Methylprednisolone - therapeutic use; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Patients; Pregnancy; Respiratory Tract Infections - complications; Treatment Outcome
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s004150200012

To establish an adequate definition of acute disseminated encephalomyelitis (ADEM) in adults, based on our clinical observations of a case-series. Over a period of three years 10 adult patients with a para- or postinfectious disseminated (diffuse or multifocal) syndrome of the CNS fulfilling predefined strict criteria for the diagnosis of ADEM were encountered and systematically followed. The age ranged from 21 to 62 years, two were men. MRI was normal in 5 patients and only mildly abnormal in the remaining patients. CSF was normal in 5 patients and mildly abnormal in the remainder, EEG was abnormal in 7/8 patients. All patients survived and were followed over a period of 30 months (range: 8 to 48 months). Nine patients were left with some residual defects, consisting most often of a mild cognitive impairment. The EEG as an investigation of brain function can be crucial in establishing the organic nature of disease. MRI is important to exclude other diffuse or multifocal encephalopathies. However, in contrast to previous reports in the literature abnormal MRI should not be considered mandatory in adult ADEM. Difficulties in the diagnosis of ADEM are discussed and the importance of clinical and paraclinical findings for establishing the diagnosis is outlined.