J Korean Child Neurol Soc.  2013 Sep;21(3):176-183.

Acute Disseminated Encephalomyelitis with Psychotic and Parkinsonian Features: A Case Report

• Shim E
• Yum MS
• Kim EH
• Choi HW
• Ko TS

Abstract

Acute disseminated encephalomyelitis (ADEM) is a monophasic immune-mediated demyelination disorder that can arise following infection or immunization. Typical MRI findings show multifocal demyelinating lesions in the CNS. The presenting features include acute encephalopathy with multifocal neurologic signs, and patients often progress to develop delirium and/or coma, but acute psychosis is rare. In our current report, we describe a case of a 14-year-old boy presenting with parkinsonian features (masked face, bradykinesia, resting tremor, slow strides) as well as aggressive behavior and irritability with persecutory delusions that developed 3 days after an upper respiratory tract infection. T2-weighted/FLAIR brain MRI showed increased signal intensity in the hippocampus and basal ganglia including in the caudate nuclei. Cerebrospinal fluid (CSF) enterovirus PCR was positive. After treatment with high-dose methylprednisolone and antipsychotics, he recovered without permanent disabilities, and the initial lesions found on MRI disappeared on follow-up.

Keyword

Acute disseminated encephalomyelitis; Psychosis; Parkinsonian disorder; Enterovirus

MeSH Terms

Adolescent
Antipsychotic Agents
Basal Ganglia
Brain
Cerebrospinal Fluid
Coma
Delirium
Delusions
Demyelinating Diseases
Encephalomyelitis, Acute Disseminated*
Enterovirus
Follow-Up Studies
Hippocampus
Humans
Hypokinesia
Immunization
Magnetic Resonance Imaging
Male
Methylprednisolone
Neurologic Manifestations
Polymerase Chain Reaction
Psychotic Disorders
Respiratory Tract Infections
Tremor
Antipsychotic Agents
Methylprednisolone