J Clin Neurol.  2016 Jul;12(3):282-288. 10.3988/jcn.2016.12.3.282.

Clinical Profiles and Short-Term Outcomes of Acute Disseminated Encephalomyelitis in Adult Chinese Patients

• Yang HQ
• Zhao WC
• Yang WM
• Li YL
• Sun ZK
• Chen S
• Li W
• Ma JJ

• KMID: 2354114
• DOI: http://doi.org/10.3988/jcn.2016.12.3.282

Abstract

BACKGROUND AND PURPOSE
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that predominantly affects children. Previous studies have mostly involved children in Western developed countries.
METHODS
This study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients.
RESULTS
ADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS).
CONCLUSIONS
With the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.

Keyword

acute disseminated encephalomyelitis; multiple sclerosis; oligoclonal bands; magnetic resonance imaging

MeSH Terms

Adult*
Asian Continental Ancestry Group*
Cerebrospinal Fluid
Child
Consciousness
Demyelinating Diseases
Developed Countries
Diagnosis
Encephalomyelitis, Acute Disseminated*
Fever
Follow-Up Studies
Humans
Immunoglobulin G
Magnetic Resonance Imaging
Multiple Sclerosis
Oligoclonal Bands
Recurrence
Retrospective Studies
Seasons
Steroids
Immunoglobulin G
Oligoclonal Bands
Steroids

Figure

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  Fig. 1 Representative MRI findings in ADEM patients. The figure shows various lesions involving the brainstem (A), brachium pontis (B), cerebellum (C), frontal, temporal, and parietal lobes (D-F), and spinal cord (G) in ADEM patients. The inset picture in the sagittal view of the spinal cord lesion (G) shows an axial sequence. FLAIR (A, B, and E) and axial T2-weighted (F and G) images show lesions of various sizes. Nodular, patchy (C and D), and ring-shaped (H) enhancement types were observed following the administration of gadolinium. ADEM: acute disseminated encephalomyelitis.

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