Abstract

POSADA BUSTOS, Sebastián  and  ESPINOSA GARCIA, Eugenia. Acute disseminated encephalomyelitis: simulating cerebrovascular disease in an adolescent. Acta Neurol Colomb. [online]. 2021, vol.37, n.1, pp.33-38.  Epub May 06, 2021. ISSN 0120-8748.  https://doi.org/10.22379/24224022360.

Acute disseminated encephalomyelitis (ADEM) is a low-prevalence demyelinating disease of the central nervous system (CNS) with a predominance of presentation in the pediatric population.

To describe and review the clinical presentation of a patient with ADEM, its diagnostic process and therapeutic management according to the available evidence.

A 17-year-old male adolescent, with a 2-week history of high-intensity right-sided headache, stitching type, subsequent acute multifocal neurological compromise with encephalopathy, hemiparesis, and diplopia. A contrast-enhanced brain resonance study with evidence of hyperintense lesions at the level of the stem, cerebellum, and basal ganglia, asymmetric, unilateral, acute, following the vascular path of the posteroinferior cerebellar artery (PICA), but without restriction to diffusion or changes on the ADC map, so that an initial suspicion of cerebrovascular event (CVD) is made, studying with normal angioresonance, diagnostic aids for negative cardioembolic causes and thrombophilias. Considering that lesions do not suggest changes of ischemic origin, but if they are demyelinating, management with methylprednisolone pulses with resolution of hemiparesis and encephalopathy is initiated. In the 18-month follow-up, the patient has not presented new clinical or radiological events.

ADEM, is an infrequent pathology in pediatric age, with a diagnosis based on the clinic and magnetic resonance imaging findings, its clinical presentation may be nonspecific and as in this case simulate cerebrovascular disease, the treatment is based on immunomodulatory treatment, mainly corticosteroids, with a favorable recovery rate in the previously reported series.

Keywords : encephalomyelitis, acute disseminated; brain diseases; pediatrics (MeSH).

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