Resolution of Acute Disseminated Encephalomyelitis Following Termination of Pregnancy

Abstract

Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune illness characterized by inflammation of central nervous system myelin with resultant white matter damage. ADEM includes a wide variety of clinical presentations, thus contributing to a complex differential diagnosis. It most frequently occurs in children during winter or spring months following an upper respiratory infection by viruses, such as Epstein Barr, coxsackie, coronavirus, cytomegalovirus, hepatitis A, human immunodeficiency virus, influenza, measles, rubella, varicella, and West Nile virus. Alternatively, it may result from a variety of bacterial or parasitic infections. Nearly 5% of cases are precipitated by immunization, with measles/mumps/rubella vaccine being the most frequent cause. Common clinical features of ADEM include fever, altered mental status, hemiparesis, ataxia, cranial neuropathies, and spinal cord dysfunction. Severe casesmay be accompanied by seizures or coma, as neurological signs are referable to the location of the lesion burden. Although the exact pathophysiology remains unclear, a hypersensitivity reaction with demyelination is implicated. The prognosis varies and the outcome may be fatal. Surviving patients exhibit varying degrees of recovery and often do not return to their previous baseline functioning. Received April 4, 2013; revised May 20, 2013; accepted May 21, 2013. From Department of Psychiatry and Behavioral Sciences, University of Louisville School ofMedicine, Louisville, KY; BurlingtonNeurology& Sleep Clinic, West Burlington, IA ; Ochsner Medical Center Main Campus, New Orleans, LA. Send correspondence and reprint requests to Steven Lippmann, M.D., University of Louisville School of Medicine, Ambulatory Care Building—first floor, 550 S Jackson Street, Louisville, KY 40202; e-mail: sblipp01@louisville.edu & 2014 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. Case Report