Neuropsychiatric features of acute disseminated encephalomyelitis: a review

Acute Confusion in a Middle-Aged Woman

This is a report of a previously healthy 47-year-old lady who presented to the Accident & Emergency Department (AED) with acute confusion. She was subsequently diagnosed to be suffering from acute disseminated encephalomyelitis (ADEM). We report this rare case to alert emergency physicians to consider acute disseminated encephalomyelitis when presented with a patient with acute confusion. The diagnosis, investigation, management will be discussed.

Acute disseminated encephalomyelitis presenting as depressive episode

A 9-year-old girl presented to the Child Guidance Clinic with clinical features suggestive of depressive episode of 1 week duration. There was history of short febrile illness 3 weeks prior to the onset of the depressive symptoms. MRI scan of brain showed features of acute disseminated encephalomyelitis.

Neurocognitive outcome after acute disseminated encephalomyelitis

Cognitive dysfunction has been demonstrated in multiple sclerosis but has not been extensively studied after acute disseminated encephalomyelitis (ADEM). Because ADEM often presents with widespread demyelination, which may not completely resolve, these patients may be at risk for persistent cognitive dysfunction. The study objective was to explore the profile and severity of neurocognitive sequelae in pediatric ADEM. Children aged 6-15 years diagnosed with ADEM were invited to participate in a structured neurologic assessment, neuropsychological evaluation, and a follow-up magnetic resonance imaging. Nine of 15 children diagnosed with ADEM met the age criteria and six participated in the study. The mean age at presentation was 7.7 years; the mean duration of follow-up was 3.5 years. As a group, these children with prior ADEM performed within the average range on cognitive testing. However, a variety of mild cognitive deficits were demonstrated in each of the children, even in those whose magnetic resonance imaging studies had completely normalized. Four children demonstrated a cognitive profile of relatively poorer visuospatial/visuomotor function. The cognitive deficits observed in these children are similar but less severe than those previously reported in adults and children with multiple sclerosis, which may reflect the monophasic nature of ADEM, compared with the chronic, recurrent demyelination characteristic of multiple sclerosis.

Postinfectious encephalomyelitis

Postinfectious forms of encephalomyelitis, also termed acute disseminated encephalomyelitis (ADEM), form one of several categories of inflammatory demyelinating disorders of the central nervous system (CNS). Recent large, retrospective case series have refined our understanding of the clinical, laboratory, and neuroimaging characteristics of ADEM. The differences between childhood and adult ADEM, risks of development of multiple sclerosis, and the contributions of recent studies to refining the nosology of CNS demyelinating syndromes are discussed.

Acute disseminated encephalomyelitis: recognition in the hands of general paediatricians

Acute disseminated encephalomyelitis will often present to the general paediatrician as an acute polysymptomatic encephalopathy, and initially the diagnosis may not be clear. A brain MRI scan is essential in establishing the diagnosis and so enabling appropriate advice and treatment to be given. Multicentre clinical audit of outcome and controlled therapeutic trials are needed to secure an evidence base for current practice.