Clinical and imageology follow-up study of acute disseminated encephalomyelitis

Abstract

Objective To explore the clinical manifestations and recovery from neuroimaging abnormalities of acute disseminated encephalomyelitis (ADEM), in order to improve the understanding of ADEM. Methods A total of 47 children with ADEM in Department of Neurology, Children′s Hospital of Soochow University were followed up for 1 year.The clinical manifestations, auxiliary examination (especially neuroimaging), treatment and prognosis were analyzed.The recovery conditions from clinical and neuroimaging abnormalities were summarized. Results Among 47 cases, 37 cases (78.72%) had prodromic infection history, and 5 cases (10.64%) had the history of vaccination.The clinical manifestations were varied, including 36 cases (76.60%) with somatic discomfort, 30 cases (63.83%) with fever, 30 cases (63.83%) with disturbance of consciousness, 28 cases (59.57%) with epileptic seizure, 24 cases (51.06%) with headache and dizziness, 22 cases (46.81%) with nausea and vomiting, 15 cases (31.91%) with dyskinesia, 15 cases (31.91%) with cranial nerve injury, 9 cases (19.14%) with incoordination, and 8 cases (17.02%) with mental and behavior disorders.Abnormal lesions presented multiple, asymmetric patchy and large patchy signal image showed by brain magnetic resonance imaging (MRI), and 7 cases (14.89%) involved the spinal cord.All patients received the treatment of Methylprednisolone [15-20 mg/(kg·d)] combined with intravenous gamma globulin (total 2 g/kg, 3 to 5 days). The dose of Methylprednisolone gradually decreased after it had been used for 3 days.In the end, it was replaced by an oral administration of Prednisone [1.0-2.0 mg/(kg·d)], and the total treatment period was for 2-3 months.The follow-ups of 47 children with ADEM showed that the MRI lesions of all the children were reduced and the MRI lesions in 4 (8.51%) of them disappeared completely after 0.5 month of follow-up; the lesions disappeared completely in 13 cases (27.66%) after 1 month of follow-up; the lesions disappeared completely in 23 cases (48.94%) after 3 months of follow-up; the lesions disappeared completely in 32 cases (68.09%) after 6 months of follow-up; the lesions disappeared completely in 43 cases (91.49%) after 1 year of follow-up; and finally there were 4 cases (8.51%) with residual lesions. Conclusion The clinical manifestations of children with ADEM are varied.Most children with ADEM have a favorable prognosis.Imaging lesions of 68.09% of the cases completely disappeared after the onset of 6 months.Imaging lesions in 91.49% of the cases completely disa-ppeared at the onset of 1 year.Only a small fraction of patients present permanent lesions. Key words: Acute disseminated encephalomyelitis; Clinical manifestation; Neuroimaging; Magnetic resonance imaging; Child