Acute Disseminated Encephalomyelitis: A Review of Eleven Cases in Childhood in North of Iran

Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder. The pathogenesis is unclear, but it is thought to be immune-mediated. The prognosis is favorable, with most children making a full recovery. Objectives: The present report analyzed different clinical presentations, response to treatment and outcome in a series of ۱۱ patients with ADEM who referred to our tertiary center in north of Iran from ۲۰۱۰ to ۲۰۱۴. Materials and Methods: In this retrospective simple descriptive review, eleven cases with ADEM admitted in the neurology ward from ۲۰۱۰ to ۲۰۱۴ were enrolled. The clinical findings and laboratory and imaging results of patients were reviewed. All of these cases were evaluated with neurological examination, serologic tests for bacterial meningitis and viral encephalitis (especially, herpes simplex virus) and brain MRI without contrast. After discharge, patients were followed for at least six months (۶ to ۱۲ months) clinically and radiologically. Results: Of ۱۱ children, ۸ were male and ۳ female. Their ages ranged between ۴ and ۱۰ years. The mean interval between the preceding infection and symptoms of encephalomyelitis was nine days. The most common presenting symptoms were ataxia in ۴۵.۴%, fever and headache in ۳۶.۴% and altered consciousness in ۱۸.۲% of patients. Neurological examination revealed pyramidal motor signs such as brisk deep tendon reflexes (hyperreflexia) (۸۱.۸%), cranial nerve involvement (۱۸.۲%), dysarthria (۹.۱%) and abnormal movements (۹.۱%). We followed up these patients in long-term for ۶ to ۱۲ months. Only in ۱ child who received IVIG, mild ataxia had reminded. Conclusions: The prognosis of acute disseminated encephalomyelitis (ADEM) is favorable. Early diagnosis and prompt treatment of ADEM would probably reduce morbidity.

Keywords:

Acute Disseminated Encephalomyelitis , ADEM , Children , Outcome , Iran , Case Series