Clinical Neuroscience

[Acute disseminated encephalomyelitis in childhood]

LIPTAI Zoltán1, ÚJHELYI Enikő2, MIHÁLY Ilona3, RUDAS Gábor4, BARSI Péter5

JULY 22, 2009

Clinical Neuroscience - 2009;62(07-08)

[Background and purpose - Acute disseminated encephalomyelitis is a rare inflammatory demyelinating disorder often preceded by infection or vaccination. The purpose of the study was the systematic analysis of clinical, radiological and microbiological profiles of children treated at Szent László Hospital, and the comparison of findings with literature data. Methods - Demographic, infectological, clinical, radiological, laboratory and virological data of patients treated and followed-up between 1-Jan-1998 and 30-June-2008 were reviewed and analysed. Results - 19 children met diagnostic criteria. Their mean age was 6.8 years. A prodromal illness - mostly febrile viral infection, upper respiratory infection or chickenpox - preceded neurological symptoms in 17 patients. All had polysymptomatic encephalopathy, 2 children had spinal symptoms. The cerebrospinal fluid was abnormal in all but one. A viral etiology was definite in 7 and probable in 8 cases. MRI disclosed white matter changes in 18, cortical and deep gray matter in 16, cerebellar in 6, brain stem in 14 and spinal cord changes in 2 cases. Repeat MRI performed mean 4 months later showed complete resolution in 6 and partial resolution in 11 patients. 13 patients received high-dose methylprednisolone, 2 of whom were also treated with plasma exchange and 1 with immunoglobulin. 9 children required mechanical ventilation. 2 patients died, 10 recovered without and 7 with sequelae. 2 patients developed further demyelinating events: multiple sclerosis and multiphasic disseminated encephalomyelitis, respectively. Conclusion - Clinical, radiological and follow-up results were similar to those published in literature however, triggering viruses were identified in a larger proportion of cases.]

AFFILIATIONS

  1. Fôvárosi Önkormányzat Szent István és Szent László Kórháza, Gyermekgyógyászati Osztály, Budapest
  2. Fôvárosi Önkormányzat Szent István és Szent László Kórháza, Gyermekintenzív Osztály, Budapest
  3. Fôvárosi Önkormányzat Szent István és Szent László Kórháza, Mikrobiológiai Laboratórium, Budapest
  4. Semmelweis Egyetem, MR-Kutatóközpont, Budapest
  5. Radlingua Közkereseti Társaság, Páty

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