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de Medeiros Rimkus C, Fragoso DC, Apóstolos Pereira SL, da Costa Leite C. Atypical Demyelinating Disorders: MR Imaging Features, Atypical Triggers, and Etiopathogenesis. Neuroimaging Clin N Am 2024; 34:421-438. [PMID: 38942525 DOI: 10.1016/j.nic.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Atypical demyelinating lesions (ADLs) can be idiopathic, occurring as isolated and self-limited events, or can appear in different stages of relapsing demyelinating diseases. Not infrequently, ADLs occur in inflammatory syndromes associated with exogenous or endogenous toxic factors, metabolic imbalance, or infectious agents. It is important to recognize imaging patterns that indicate an inflammatory/demyelinating substrate in central nervous system lesions and to investigate potential triggers or complicating factors that might be associated. The prognostic and treatment strategies of ADLs are influenced by the underlying etiopathogenesis.
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Affiliation(s)
- Carolina de Medeiros Rimkus
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 75, Cerqueira Cesar, São Paulo-SP, 05403-010, Brazil; Instituto D'Or de Ensino e Pesquisa (IDOR), Av. Brigadeiro Luís Antônio, 5001 - Jardim Paulista, São Paulo - SP - CEP 01401-002; MS Center, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Diego Cardoso Fragoso
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 75, Cerqueira Cesar, São Paulo-SP, 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo - SP, 04580-060, Brazil
| | - Samira Luisa Apóstolos Pereira
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Sala 5083, 5° andar - Cerqueira César, São Paulo-SP, 05402-000, Brazil
| | - Claudia da Costa Leite
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 75, Cerqueira Cesar, São Paulo-SP, 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo - SP, 04580-060, Brazil
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Mukhtiar K, Raza M, Ishaque S, Maha Q, Noor A. Clinical pattern, neuroimaging findings and outcome of Acute Disseminated Encephalomyelitis in children: A retrospective study. Pak J Med Sci 2024; 40:1479-1484. [PMID: 39092058 PMCID: PMC11255823 DOI: 10.12669/pjms.40.7.8015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To determine the clinical spectrum, neuroimaging findings, and outcome of Acute Disseminated Encephalomyelitis (ADEM) in children. Method We conducted a descriptive cross sectional study of all children aged 6 months to 18 years, diagnosed with ADEM at Aga Khan University Hospital, Karachi from January 2018 till December 2022. Results This retrospective study enrolled 30 cases of ADEM, with a mean age of 6.43 ± 4.079, including 13 males and 17 females. The average hospital stay was 7.29 ± 4.379 days. The most common clinical features were fever, headache, and altered consciousness, while motor deficit was observed in 15 (53.5%) patients. Abnormal cerebrospinal fluid was found in 14 (46.6%) patients. Brain MRI identified bilateral and multifocal lesions in 22 (78.6%) patients, with brainstem lesions detected in 7 (25%) patients. Treatment included IV methylprednisolone (22; 73%), IVIG (9; 30%), or both (6; 20%). Clinical improvement was observed in 25 (89.3%) patients, with residual weakness present in eight (26%) patients at discharge. There was one reported death. Long-term complications included motor deficits, seizures, poor scholastic performance, and behavioral issues. Conclusion The clinical presentation of ADEM is variable, but the most common symptoms are fever, headache, and altered consciousness. Despite generally favorable outcome, long-term monitoring revealed that patients may experience motor deficits, seizures, cognitive impairment, and academic difficulties.
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Affiliation(s)
- Khairunnisa Mukhtiar
- Khairunnisa Mukhtiar, Assistant Professor, Department of Pediatrics & Child Health, Section of Pediatric Neurology, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Raza
- Mohammad Raza, Instructor, Department of Pediatrics & Child Health, Section of Pediatric Neurology, Aga Khan University Hospital, Karachi, Pakistan
| | - Sidra Ishaque
- Sidra Ishaque, Assistant Professor, Department of Pediatrics & Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Quratulain Maha
- Quratulain Maha, Intern, Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayesha Noor
- Ayesha Noor Intern, Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Codreanu-Balaban RA, Stuparu AZ, Musat D, Baz RA, Baz R, Docu-Axelerad S, Vranau DM, Tase CR, Gogu AE, Jianu DC, Frecus CE, Muja LF. Acute disseminated encephalomyelitis in a young patient: A case report. Exp Ther Med 2024; 28:323. [PMID: 38939178 PMCID: PMC11208760 DOI: 10.3892/etm.2024.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024] Open
Abstract
The diagnosis of acute disseminated encephalomyelitis (ADEM) is challenging due to the existence of other medical conditions that mimic its symptoms and the lack of precise biomarkers. Timely diagnosis is essential for commencing an appropriate treatment, which enhances the clinical trajectory and long-term prognosis. The purpose of the present study was to emphasize significant concerns, specifically for neurologists and radiologists, due to the difficulties involved in identifying this disorder. Neurologists must have an extensive understanding of the clinical manifestations and constraints of current diagnostic tests. Furthermore, this understanding is equally essential for radiologists, as it serves as the foundation for precise diagnostic interpretations derived from imaging findings. The intricate nature of neurological disorders frequently necessitates a cooperative effort between neurologists and radiologists to guarantee precise diagnosis and efficient therapy strategizing. The present study discusses a case of a male patient who was diagnosed with ADEM based on clinical, biological and imaging evaluations.
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Affiliation(s)
| | - Alina Zorina Stuparu
- Department of Neurology, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Neurology, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
| | - Daniela Musat
- Department of Neurology, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
| | - Radu-Andrei Baz
- Department of Radiology and Imaging Laboratory, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
| | - Radu Baz
- Department of Radiology and Imaging Laboratory, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
| | - Silviu Docu-Axelerad
- Faculty of General Medicine, ‘Titu Maiorescu’ University, 040441 Bucuresti, Romania
| | - Diana-Marina Vranau
- Department of Neurology, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
| | - Cristina Ramona Tase
- Department of Neurology, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
| | - Anca Elena Gogu
- Department of Neurology, ‘Victor Babeș’ University of Medicine and Pharmacy, Timișoara 300041, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Faculty of Medicine, ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, ‘Victor Babeș’ University of Medicine and Pharmacy, Timișoara 300041, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Faculty of Medicine, ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Corina Elena Frecus
- Department of Pediatrics, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Pediatrics, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
| | - Lavinia-Florenta Muja
- Department of Neurology, ‘Sf. Ap. Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Neurology, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
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Balaji N, Ignatowicz A, Kalra A, Mansour R, Jadhav V. Anti-CASPR2 Antibody-Associated Autoimmune Encephalitis Presenting as Refractory Seizures. Cureus 2024; 16:e64317. [PMID: 39131008 PMCID: PMC11316415 DOI: 10.7759/cureus.64317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Autoimmune encephalitis (AE) is a rare immune-mediated disorder comprised of non-infectious neuroinflammatory disease processes. Clinical presentation overlaps with a broad range of neurodegenerative disorders and infectious encephalitis; therefore, AE remains a diagnosis of exclusion. Patients may present with nonspecific symptoms such as psychiatric disturbances, cognitive deficits, seizures, movement disorders, and confusion. Prompt diagnosis and management are necessary for patients with AE to decrease mortality and improve quality of life. First-line therapy includes immunosuppression with corticosteroids, intravenous immunoglobulin, and plasmapheresis. We report the case of an 86-year-old female with a medical history of Parkinson's disease who presented with nonspecific seizure-like activity and was diagnosed with AE.
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Affiliation(s)
- Nivedha Balaji
- Internal Medicine, Northeast Georgia Medical Center Gainsville, Gainesville, USA
| | | | - Aarushi Kalra
- Internal Medicine, Northeast Georgia Medical Center Gainsville, Gainesville, USA
| | - Rami Mansour
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, USA
| | - Vaishali Jadhav
- Internal Medicine, Northeast Georgia Medical Center Gainsville, Gainesville, USA
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Naggar A, Laasri K, Kabila B, Izi Z, Allali N, Haddad SE, Chat L. Myelin insults differentials on MRI in children: In the light of an ADEM case. Radiol Case Rep 2024; 19:408-413. [PMID: 38033671 PMCID: PMC10681876 DOI: 10.1016/j.radcr.2023.08.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute and rapidly progressive auto-immune demyelinating disorder in the central nervous system. It is a rare disease but is more frequently observed in the pediatric population. We report a case of a monophasic postvaccination ADEM, which presented with paraparesis associated with fever. It showed a favorable evolution under corticosteroids, without recurrence after 3 years of follow-up. The diagnosis was established due to the postvaccination context and the MRI abnormalities characteristics. This case prompted a general discussion about the etiologies of myelin insults in children, especially demyelinating disorders, by shedding the light on their MRI features.
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Affiliation(s)
- Amine Naggar
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Khadija Laasri
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Badr Kabila
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Zineb Izi
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Pediatric Teaching Hospital, Mohammed V University, Rabat, Morocco
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Sadekova GI, Boyko AN. [Modern pathogenetic treatment of rare demyelinating diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:33-36. [PMID: 39175237 DOI: 10.17116/jnevro202412407233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Rare demyelinating diseases are a group of diseases whose pathogenesis is based on the process of demyelination. This group of diseases includes acute multiple encephalomyelitis (ADEM), opticoneuromyelitis spectrum diseases (NMOSD) and anti-myelin-oligodendrocyte glycoprotein-associated diseases (MOG-antibodies-associated diseases - MOGAD). Recently, new biological drugs for pathogenetic therapy have been developed, which have shown their effectiveness and good tolerability in comparison with therapy with first- and second-line drugs. Aim of the study - analysis of modern possibilities of pathogenetic treatment of patients with ADEM, seronegative and seropositive patients with NMOSD. The analysis was carried out on the basis of English-language publications in PubMed published over the past five years. This review summarizes current ideas about the possibilities of pathogenetic treatment of rare diseases. The advantages of using ravulizumab over other representatives of a new biological therapy associated with the use of monoclonal antibodies are shown. The analyzed data allow us to conclude that there is a significant development of pathogenetic treatment options for ZSONM. However, the effectiveness of new therapeutic biological drugs is still limited due to the lack of a large amount of clinical data to confirm, which creates the need to continue analyzing the experience of their use.
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Affiliation(s)
- G I Sadekova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
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Khatri S, Xerras M, Chamay S, Sharma S. Insights from neuroradiology in acute disseminated encephalomyelitis. Radiol Case Rep 2023; 18:4318-4322. [PMID: 37789924 PMCID: PMC10542600 DOI: 10.1016/j.radcr.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated demyelinating disorder primarily observed in children, typically triggered by recent vaccination or viral infection. Although uncommon, there have been reports of ADEM occurring in adults, with varying radiological findings compared to pediatric cases. Distinguishing ADEM from other demyelinating disorders, such as multiple sclerosis (MS) and neuromyelitis optica (NMO), can pose a diagnostic challenge. We present a case report of an 18-year-old male with a history of polysubstance use who was successfully treated with corticosteroids and highlight the neuroradiological presentation of ADEM, emphasizing the importance of accurate diagnosis and management in both pediatric and adult populations.
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Affiliation(s)
| | | | - Salomon Chamay
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
| | - Shorabh Sharma
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
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Campbell D, Wong GS, Park H, McLeod G. An Adult Case of Adenovirus-Associated Acute Disseminated Encephalomyelitis. Case Rep Infect Dis 2023; 2023:5528198. [PMID: 37261248 PMCID: PMC10228215 DOI: 10.1155/2023/5528198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an autoimmune neurological disease that predominately affects pediatric population. Only a single fatal adult case of adenovirus-associated ADEM has previously been published by Qamar et al. in 2021. Here, we present an adult case of adenovirus-associated ADEM, which was diagnosed early in her clinical course. The patient was treated with the prompt initiation of steroids, intravenous immune globulin (IVIG), and plasmapheresis (PLEX), and the patient recovered fully. This case highlights the importance of early accurate diagnosis for other clinicians to treat adenovirus-associated ADEM in a timely fashion to prevent a potentially fatal outcome.
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Affiliation(s)
- Dewayne Campbell
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Gordon S. Wong
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Hyun Park
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
| | - Gavin McLeod
- Department of Internal Medicine, Yale New Haven Health, Greenwich Hospital, Greenwich, CT, USA
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Huq MR, Kawnayn G, Kabir H, Chowdhury MI, Anwar MB. Acute Vaccine-Related Encephalopathy and Acute Disseminated Encephalomyelitis (ADEM) After COVID-19 Vaccination: A Case Series From Bangladesh. Cureus 2023; 15:e39724. [PMID: 37398807 PMCID: PMC10310056 DOI: 10.7759/cureus.39724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 07/04/2023] Open
Abstract
There are several reported cases of various neurological adverse effects following the COVID-19 vaccination globally. Acute vaccine-related encephalopathy and acute disseminated encephalomyelitis (ADEM) are included among them. Here we are reporting three cases of ADEM and one case of acute vaccine-related encephalopathy from Bangladesh, which have a possible association with COVID-19 vaccines. All three ADEM cases were elderly; two cases developed symptoms after receiving the second dose of the Sinopharm vaccine, and another case after receiving the second dose of the Sinovac vaccine. We have treated another case of acute vaccine-related encephalopathy following receiving the Moderna vaccine. The patients had features of encephalopathy, including altered consciousness and convulsions. The ADEM cases had MRI (magnetic resonance imaging) brain findings suggestive of ADEM. The other case had normal MRI findings. All the cases were treated with intravenous corticosteroids with full recovery, except for one ADEM patient, who developed aspiration pneumonia and died. Though it is not possible to conclude that COVID-19 vaccination is the causative agent behind these cases, this case series will help to increase awareness regarding the early detection and treatment of these serious adverse effects.
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Alqarni AA, Aljafari DA, Alzahrani FA, Alharthi AA, Alhubayshi MS. Acute Disseminated Encephalomyelitis Post COVID-19 Pneumonia. Cureus 2023; 15:e34615. [PMID: 36891024 PMCID: PMC9986969 DOI: 10.7759/cureus.34615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/07/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a monophasic condition characterized by inflammation of the central nervous system. Besides multiple sclerosis, optic neuropathy, acute transverse myelitis, and neuromyelitis optica spectrum disorder, ADEM is a primary inflammatory demyelinating disorder of the central nervous system. It is estimated that approximately three-quarters of cases of encephalomyelitis occur after an infection or immunization, where the onset of neurological disease is coincident with a febrile event. Here, we report an 80-year-old woman with coronavirus disease pneumonia who developed sudden onset of decreased level of consciousness, focal seizure, and right-side weakness. Magnetic resonance imaging (MRI) of the brain showed a multifocal hemorrhagic lesion with surrounding edema, suggesting ADEM. An electroencephalogram (EEG) revealed moderate generalized encephalopathy. The patient received alternating pulse steroids with plasma exchange for five days. Subsequently, her Glasgow coma scale score continued to decrease, and thus, she required inotropic support until she expired.
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Affiliation(s)
- Abdulaziz A Alqarni
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Danya A Aljafari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Faris A Alzahrani
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | | | - Madihah S Alhubayshi
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
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Lim H, Hwang SK, Lee YJ, Kwon S. The Wide Variety of Acute Disseminated Encephalomyelitis in Children: A Clinical Perspective. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating inflammatory disorder of the central nervous system. It is characterized by encephalopathy, multifocal neurological deficits, and typical magnetic resonance imaging findings of widespread demyelinating lesions, predominantly involving the white matter of the brain and spinal cord. ADEM mainly affects children and is commonly associated with preceding viral and bacterial infections, and, rarely, vaccinations. Despite substantial advances in the understanding of the association of myelin oligodendrocyte glycoprotein antibody with recurrent forms of ADEM or other demyelinating conditions, specific etiologic agents or biological markers have not been identified. Therefore, the diagnosis of ADEM is still based on clinical and radiological findings and the exclusion of other conditions mimicking ADEM. However, a prompt diagnosis and adequate treatment are crucial because diagnostic delays or inappropriate treatment may lead to unwanted neurological sequelae in some children. There is no standardized treatment protocol for ADEM, but the use of corticosteroids, intravenous immunoglobulin, and plasmapheresis has been associated with good clinical outcomes. Adequate treatment has reportedly resulted in favorable outcomes, with full or almost full recovery in most children with ADEM, although some children may develop neurological sequelae, such as cognitive impairment and motor deficits. Further studies are needed to identify biological clues and optimal treatment protocols to minimize the incidence of neurological sequelae.
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Verriello L, Pez S, Pauletto G, D'Agostini S, Nilo A, Gigli GL, Valente M. Neurological disorders in COVID-19: a case of Acute Disseminated Encephalomyelitis in an adult patient. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e20222140. [PMID: 35765956 PMCID: PMC10510960 DOI: 10.23750/abm.v93is1.12885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Abstract
Different neurological complications associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection have been widely documented. Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated demyelinating disorder, described within the spectrum of neurological manifestations of COVID-19. Herein, we describe a case of adult-ADEM presenting with diplopia and slowly progressive ataxia developed one month after SARS-CoV-2 infection. Brain magnetic resonance imaging (MRI) revealed acute multifocal demyelinating lesions throughout the brain. Other possible etiologies have been ruled out. After treatment with high-dose steroids, we observed a progressive clinical and radiological improvement. A 4-months follow-up showed complete clinical recovery. Although extremely rare, ADEM could be associated to SARS-CoV-2 infection and should be considered in the differential diagnosis. Early recognition of this COVID-19 neurological complication, even in the absence of pulmonary involvement, is important to start a prompt immune-modulatory treatment and, consequently, ensure a good outcome.
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Affiliation(s)
- Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Sara Pez
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Italy.
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Serena D'Agostini
- Neuroradiology Unit, Department of Radiology, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Italy.
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Italy.
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Italy.
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Li K, Li M, Wen L, Wang Q, Ding X, Wang J. Clinical Presentation and Outcomes of Acute Disseminated Encephalomyelitis in Adults Worldwide: Systematic Review and Meta-Analysis. Front Immunol 2022; 13:870867. [PMID: 35757742 PMCID: PMC9218070 DOI: 10.3389/fimmu.2022.870867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
Background Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disorder that is often misdiagnosed. To improve early diagnosis, we performed a systematic review and meta-analysis of clinical features, outcomes for ADEM in adults. Methods The PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies reporting the clinical features of adults with ADEM between January 1990 and May 2021. A random-effects meta-analysis model was used to pool data on clinical features and functional outcomes. Results Twelve studies examining 437 adults with ADEM met the inclusion criteria. Overall, the clinical features and diagnostic findings observed in more than two-thirds of the patients were white matter lesions [87.1%, 95% confidence interval (CI)=75-95.6], polyfocal onset (80.5%, 95% CI=50.5-98.9) and pyramidal signs (68.7%, 95% CI =40.0-91.9). The mortality rate was 7.8% (95% CI = 3.3–13.5), and the risk of residual deficits was 47.5% (95% CI = 31.8–63.4). Conclusions Adults with ADEM had worse outcomes than children. Clinicians should maintain high clinical suspicion for patients presenting with certain clinical features and diagnostic findings.
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Affiliation(s)
- Kunyi Li
- Department of Neurology, the Second People's Hospital of Chengdu, Chengdu, China
| | - Maolin Li
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Lan Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiancheng Wang
- Department of Neurology, Chongqing North-Kuanren General Hospital, ChongQing, China
| | - Xin Ding
- Department of Neurology, the Second People's Hospital of Chengdu, Chengdu, China
| | - Jian Wang
- Department of Neurology, the Second People's Hospital of Chengdu, Chengdu, China
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Serrallach BL, Orman G, Boltshauser E, Hackenberg A, Desai NK, Kralik SF, Huisman TAGM. Neuroimaging in cerebellar ataxia in childhood: A review. J Neuroimaging 2022; 32:825-851. [PMID: 35749078 DOI: 10.1111/jon.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/27/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022] Open
Abstract
Ataxia is one of the most common pediatric movement disorders and can be caused by a large number of congenital and acquired diseases affecting the cerebellum or the vestibular or sensory system. It is mainly characterized by gait abnormalities, dysmetria, intention tremor, dysdiadochokinesia, dysarthria, and nystagmus. In young children, ataxia may manifest as the inability or refusal to walk. The diagnostic approach begins with a careful clinical history including the temporal evolution of ataxia and the inquiry of additional symptoms, is followed by a meticulous physical examination, and, depending on the results, is complemented by laboratory assays, electroencephalography, nerve conduction velocity, lumbar puncture, toxicology screening, genetic testing, and neuroimaging. Neuroimaging plays a pivotal role in either providing the final diagnosis, narrowing the differential diagnosis, or planning targeted further workup. In this review, we will focus on the most common form of ataxia in childhood, cerebellar ataxia (CA). We will discuss and summarize the neuroimaging findings of either the most common or the most important causes of CA in childhood or present causes of pediatric CA with pathognomonic findings on MRI. The various pediatric CAs will be categorized and presented according to (a) the cause of ataxia (acquired/disruptive vs. inherited/genetic) and (b) the temporal evolution of symptoms (acute/subacute, chronic, progressive, nonprogressive, and recurrent). In addition, several illustrative cases with their key imaging findings will be presented.
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Affiliation(s)
- Bettina L Serrallach
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nilesh K Desai
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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15
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Salunkhe M, Vibha D, Singh RK, Varasi E, Tripathi M. Acute disseminated encephalomyelitis: an evolving spectrum. Neurol Sci 2022; 43:4019-4022. [DOI: 10.1007/s10072-022-06032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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16
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González-Rodríguez B, González-Rodríguez M, Bejarano Ramírez N, Redondo Calvo FJ. Optic neuritis as sign presentation of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:223-224. [PMID: 35212501 PMCID: PMC8972703 DOI: 10.37201/req/112.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 06/14/2023]
Affiliation(s)
- B González-Rodríguez
- Beatriz González-Rodríguez, Virgen de la Salud Hospital, Toledo. Barber Avenue, 30. Zip Code 45004, Toledo, Castilla La Mancha, Spain.
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17
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Magnetic Resonance Imaging of Autoimmune Demyelinating Diseases as a Diagnostic Challenge for Radiologists: Report of Two Cases and Literature Review. Life (Basel) 2022; 12:life12040488. [PMID: 35454978 PMCID: PMC9027326 DOI: 10.3390/life12040488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/12/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
The magnetic resonance characteristics of autoimmune demyelinating diseases are complex and represent a challenge for the radiologist. In this study we presented two different cases of detected autoimmune demyelinating diseases: one case of acute disseminated encephalomyelitis and one case of neuromyelitis optica, respectively. Expected and unexpected findings of magnetic resonance imaging examination for autoimmune demyelinating diseases were reported in order to provide a valuable approach for diagnosis. In particular, we highlight, review and discuss the presence of several uncommon imaging findings which could lead to a misinterpretation. The integration of magnetic resonance imaging findings with clinical and laboratory data is necessary to provide a valuable diagnosis.
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18
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Li Y, Liu X, Wang J, Pan C, Tang Z. Clinical Features and Imaging Findings of Myelin Oligodendrocyte Glycoprotein-IgG-Associated Disorder (MOGAD). Front Aging Neurosci 2022; 14:850743. [PMID: 35370624 PMCID: PMC8965323 DOI: 10.3389/fnagi.2022.850743] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/08/2022] [Indexed: 01/14/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD) is a nervous system (NS) demyelination disease and a newly recognized distinct disease complicated with various diseases or symptoms; however, MOGAD was once considered a subset of neuromyelitis optica spectrum disorder (NMOSD). The detection of MOG-IgG has been greatly improved by the cell-based assay test method. In one study, 31% of NMOSD patients with negative aquaporin-4 (AQP-4) antibody were MOG-IgG positive. MOGAD occurs in approximately the fourth decade of a person’s life without a markedly female predominance. Usually, optic neuritis (ON), myelitis or acute disseminated encephalomyelitis (ADEM) encephalitis are the typical symptoms of MOGAD. MOG-IgG have been found in patients with peripheral neuropathy, teratoma, COVID-19 pneumonia, etc. Some studies have revealed the presence of brainstem lesions, encephalopathy or cortical encephalitis. Attention should be given to screening patients with atypical symptoms. Compared to NMOSD, MOGAD generally responds well to immunotherapy and has a good functional prognosis. Approximately 44-83% of patients undergo relapsing episodes within 8 months, which mostly involve the optic nerve, and persistently observed MOG-IgG and severe clinical performance may indicate a polyphasic course of illness. Currently, there is a lack of clinical randomized controlled trials on the treatment and prognosis of MOGAD. The purpose of this review is to discuss the clinical manifestations, imaging features, outcomes and prognosis of MOGAD.
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19
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Lazaro LG, Perea Cossio JE, Luis MB, Tamagnini F, Paguay Mejia DA, Solarz H, Fernandez Liguori NA, Alonso RN. Acute disseminated encephalomyelitis following vaccination against SARS-CoV-2: A case report. Brain Behav Immun Health 2022; 20:100439. [PMID: 35252891 PMCID: PMC8886679 DOI: 10.1016/j.bbih.2022.100439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/11/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory emyelinating disease of the central nervous system that is usually considered a monophasic disease Post-vaccination ADEM has been associated with several vaccines, however, there is scarce information related to SARS-CoV-2 vaccines. We present the case of a 26- year-old female who suffered from ADEM four weeks after Gam-COVID-Vac administration.
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Affiliation(s)
- Luciana G. Lazaro
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Jhon E. Perea Cossio
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Maria B. Luis
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Flavia Tamagnini
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Diego A. Paguay Mejia
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Horacio Solarz
- Anatomical Pathology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | | | - Ricardo N. Alonso
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
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20
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Luchesa Smith A, Sudarsan N, Hemingway C, Lim M. Diagnosis and management of multiple sclerosis and other relapsing demyelinating disease in childhood. Arch Dis Child 2022; 107:216-222. [PMID: 34230009 DOI: 10.1136/archdischild-2021-321911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/15/2021] [Indexed: 11/03/2022]
Abstract
There are several important relapsing demyelinating syndromes (RDS) that may present in childhood, of which paediatric-onset multiple sclerosis is the most common. These are rare conditions, so recognising presentations and referring early to specialist services is important to enable prompt diagnosis and effective treatment. Understanding of RDS is rapidly evolving, with many new and effective treatments that aim to reduce relapses and disability accumulation. A holistic and child-focused approach to management is key to supporting patients and families, with thought given to early detection of cognitive and psychological issues to provide appropriate support.
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Affiliation(s)
| | - Nikil Sudarsan
- Department of Paediatric Neurology, Royal Alexandra Children's Hospital, Brighton, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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21
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Delehaye C, Della Corte M, Ranucci G, Prestipino E, De Brasi D, Varone A. Acute disseminated encephalomyelitis in a patient with Noonan syndrome: A rare autoinflammatory complication or coincidence? Eur J Med Genet 2021; 64:104284. [PMID: 34242782 DOI: 10.1016/j.ejmg.2021.104284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 12/16/2022]
Abstract
We describe a 13-years-old girl, previously diagnosed with PTPN11-associated Noonan Syndrome (NS), who presented to the pediatric emergency department for fever and drowsiness, which gradually worsened within 48 h. On admission, brain magnetic resonance imaging (MRI) scan showed diffuse, symmetric, multiple, poorly demarcated, confluent hyperintense lesions on MRI T2w-images, located in the Central Nervous System (CNS). In the absence of a better explanation and according to the current diagnostic criteria, a diagnosis of Acute Disseminated Encephalomyelitis (ADEM) was performed. The patient was first treated with intravenous methylprednisolone, then with intravenous immunoglobulin (IVIG). Owing to the poor clinical response, three sessions of therapeutic plasma exchange (TPE) were finally performed, with a progressive improvement. Follow-up MRI performed after three months from the onset revealed a considerable reduction in brain lesions, while cervical and dorsal ones were substantially unmodified. Neurological examination showed a full recovery of cognitive function and improved strength and tone of the upper limbs, while tetrahyporeflexia and proximal weakness of lower limbs were still appreciable. To date, this is the first described case of ADEM occurring in a patient with NS.
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Affiliation(s)
- Chiara Delehaye
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marida Della Corte
- Department of Neurosciences, Santobono-Pausilipon Pediatric Hospital, Naples, Italy.
| | - Giusy Ranucci
- Department of Pediatrics, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Elio Prestipino
- Department of Neurosciences, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Daniele De Brasi
- Department of Pediatrics, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Antonio Varone
- Department of Neurosciences, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
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22
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Solmaz I, Anlar B. Immunization in multiple sclerosis and other childhood immune-mediated disorders of the central nervous system: A review of the literature. Eur J Paediatr Neurol 2021; 33:125-134. [PMID: 34214824 DOI: 10.1016/j.ejpn.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
Childhood is a period where most vaccines are administered in order to build-up immunological memory, and immunization against vaccine-preventable diseases is an essential part of child care and health. The administration of vaccines to children with inflammatory diseases is a frequent point of concern for parents and physicians. Published information on the relation between vaccines and autoinflammatory diseases of the central nervous system (CNS) consists of case and cohort studies and reviews, in great majority on adult patients. Vaccines do not have any established causative or triggering effects on these diseases. Another issue is the immunization schedule of patients with autoinflammatory CNS diseases, specifically the interactions between the disorder, the clinical status, the treatment and the vaccine. In this review, we summarize the existing information between autoinflammatory disorders of the CNS and vaccines in childhood and underline the points to be considered under various treatment regimens.
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Affiliation(s)
- Ismail Solmaz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, 06230, Ankara, Turkey.
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, 06230, Ankara, Turkey
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23
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Update on Acute Disseminated Encephalomyelitis in Children and Adolescents. CHILDREN-BASEL 2021; 8:children8040280. [PMID: 33917395 PMCID: PMC8067441 DOI: 10.3390/children8040280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, inflammatory demyelinating disease of the central nervous system (CNS) that usually affects children and young adults after an infection or vaccination. The presence of several conditions mimicking ADEM, added to the lack of specific biomarkers, makes diagnosis potentially hard. Prompt diagnosis is necessary to start adequate treatment to improve the clinical course and long-term outcome. Because of its heterogeneity in both clinical presentation and course, challenges remain in establishing the most appropriate therapeutic approach in each patient. The aim of this review is to provide an update on management of this disease with a focus on acute treatment and to give suggestions for future research. We showed that there are currently no guidelines that help clinicians manage ADEM and therapeutic decisions are often made on a case-by-case basis. Further studies are necessary to identify clinical, laboratory, and instrumental criteria that could be correlated with outcomes and guide clinicians in choosing when and what treatment should be given in each case.
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24
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Averchenkov D, Volik A, Fominykh V, Nazarov V, Moshnikova A, Lapin S, Brylev L, Guekht A. Acute disseminated encephalomyelitis. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:119-128. [DOI: 10.17116/jnevro2021121111119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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