Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis

• Published in: Neuroradiology 1994-04, Vol.36 (3), p.221-223
• Main Authors: VAN DER MEYDEN, C. H, DE VILLIERS, J. F. K, MIDDLECOTE, B. D, TERBLANCHE, J
• Format: Article
• Language: English
• Subjects: Acute Disease; Biological and medical sciences; Biopsy, Needle; Brain - blood supply; Brain - pathology; Child; Contrast Media; Dexamethasone - administration & dosage; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Encephalomyelitis - diagnosis; Encephalomyelitis - drug therapy; Encephalomyelitis - pathology; Follow-Up Studies; Gadolinium DTPA; Humans; Magnetic Resonance Imaging - methods; Male; Medical sciences; Meninges - blood supply; Nervous system (semeiology, syndromes); Neurology; Optic Neuritis - diagnosis; Optic Neuritis - drug therapy; Optic Neuritis - pathology; Organometallic Compounds; Pentetic Acid - analogs & derivatives; Vasculitis - diagnosis; Vasculitis - drug therapy; Vasculitis - pathology
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/BF00588135

A 9-year-old boy presented with a subacute history of optic neuritis followed by brainstem involvement, with fever and a lymphocytic pleocytosis in the cerebrospinal fluid. Gadolinium-enhancing ring lesions were demonstrated in the white matter of the cerebrum, brain-stem and cerebellum on day 17 of the illness, all appearing simultaneously as part of a monophasic illness. A parietal lesion exerted mass effect. Needling and biopsy yielded no evidence of a pyogenic lesion, tumour or tuberculosis and showed vasculitis. There was insufficient material for myelin staining. Dexamethasone therapy lead to rapid improvement of the radiological lesions: MRI and CT on day 34 of the illness showed complete clearing of the lesions except for residual abnormality at the biopsy site.