| Clinical and MRI Findings of Acute Disseminated Encephalomyelitis
Associated with Preceding Infections Confirmed Serologically |
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Jung-Yeon Shim1, Tae-Sung Ko1, Hyung-Nam Moon1, Chang-Yee Hong1, Choong-Gon Choi,2, Shi-Joon Yoo2, Dae-Chul Suh2 |
1Department, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
2Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea |
| 선행 감염이 증명된 Acute Disseminated Encephalomyelitis의 임상상과 MRI 소견 |
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심정연1, 고태성1, 문형남1, 홍창의1, 최충곤2, 유시준2, 서대철2 |
1울산대학교 의과대학 서울중앙병원 소아과
2울산대학교 의과대학 서울중앙병원 진단방사선과 |
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| Abstract |
Purpose
: Acute disseminated encephalomyelitis(ADEM) is an inflammatory demyelinating disease
of the central nervous system. The pathogenesis is not well known, but it is thought to be an
immune-mediated disease and may follow a viral infection or vaccinations. MRI demonstrates
decreased signal on T1 weighting and increased signal on T2-weighted image. We report clinical
features and characteristic MRI findings in seven patients with ADEM who confirmed the preceding
infections serologically.
Methods
: Patients admitted to the Department of Pediatrics at Asan Medical Center as having
ADEM were evaluated for the preceding infections : CSF findings, MRI findings, effects of
high-dose steroids and follow-up on changes of neurological symtoms and MRI findings.
Results
: The onset of neurological symptoms from preceding infection was between 1-3 weeks.
The etiologies were Epstein-Barr virus in two, mycoplasma pneumoniae in three, and measles
virus in two cases. All lesions found in MRI were cerebral white matter lesions of which there
were subcortical white matter in three, corpus callosum in three, deep white matter in two, periventricular
white matter in one, internal capsule in one, and cerebral peduncle in one case. There
were a total of 3 cases with gray matter lesions. Two cases were treated with high- dose methyl
prednisolone, one which showed a good clinical response with much improved lesions on follow-up
T2-weighted image, but no clinical response in the other with aggravated MRI lesions. There was
1 patient with gadolinium enhancement lesion in acute phase and the lesion was completely
resolved after steroid treatment.
Conclusion
: MRI shows various features in ADEM and may be useful in diagnosis and evaluation
of clinical course. |
| Key Words:
Acute disseminated encephalomyelitis, Magnetic resonance image, High-dose steroid |
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