Adem
Download as PPTX, PDF
3 likes1,781 views
1) A 15-year-old female presented with fever, headache, vomiting and altered sensorium for a week and was diagnosed with acute disseminated encephalomyelitis (ADEM), an inflammatory disease of the central nervous system. 2) Investigations showed bilateral disc edema on fundus examination and MRI revealed extensive, multifocal white matter abnormalities. 3) Treatment involves high dose corticosteroids like methylprednisolone and intravenous immunoglobulin to reduce inflammation. The long-term risk of developing multiple sclerosis after ADEM is 25%.
Adem
- 1. IMAGE OF THE WEEK THELENGANA A PG 1STYR FROM IMCU WARD
- 2. 15 Yrs old female presented with h/o Fever 2 days Asymptomatic 10 days Headache,vomiting Altered sensorium for 1 week No h/o seizures/visual disturbance No h/o vaccination /exanthematous illness
- 3. O/E vitals were stable CNS examn :Pt was drowsy , arousable with painful stimulus PERL , DEM preserved exaggerated DTR B/L plantar extensor fundus examination B/L disc edema Other systemic examination was unremarkable
- 10. CNS TUBERCULOSIS
- 12. PML
- 13. ACUTE DISSEMINATED ENCEPHALOMYELITIS Inflammatory, nonvasculitic, demyeli nating, immune mediated, monophasic and polysymptomatic disease of the central nervous system Post infectious encephalomyelitis, Post vaccination encephalomyelitis
- 14. PATHOGENESIS Molecular mimickery: brain vaccines Th2 lymphocytes have increased reactivity to myelin basic protein Inflammatory cascade concept: CNS infections triggering immune response, damage to BBB, brain specific antigens spills into systemic circulation and initiates immunologic process
- 15. ADEM MULTIPLE SCLEROSIS PRODROMAL PHASE NO PRODROMAL PHASE ALTERED SENSORIUM PRESERVED AWARENESS MENINGISMUS NO MENINGISMUS NEUROSYCHIATRIC DISORDER NO NEUROPSYCHIATRIC B/L OPTIC NEURITIS UNILATERAL OPTIC NEURITIS COMPLETE TRANSVERSE MYELITIS INCOMPLETE SEIZURES DIPLOPIA ATAXIA RELAPSING MONOPHASIC POLYPHASIC POLYSYMPTOMATIC MONOSYMPTOMATIC
- 16. INVESTIGATIONS CSF ANALYSIS CT BRAIN MRI T2 , FLAIR, CONTRAST MTR EEG,VEP
- 17. NEUROIMAGING MRI: extensive, multifocal, subcortical white matter abnormalities MRI: subcortical white matter, may be grey matter also, CT may be normal in 50% cases Convalescent MRI helpful in diffrentating with MS, new lesions in MS
- 18. MRI Features ADEM Patchy, poorly marginated areas of increased signal intensity; large, asymmetric, multiple Four patterns: ADEM with less than 5 mm lesions Large, confluent lesions with edema and mass effect ADEM with additional symmetric bithalamic involvement Acute hemorrhagic encephalomyelitis (worst prognosis)
- 19. RECURRENCE OF ADEM RDEM MDEM
- 20. TREATMENT Broad spectrum antibiotics and acyclovir until an Infectious etiology is excluded. Methylprednisolone in a dose of 30 mg/kg per day intravenously up to a maximum dose of 1000 mg per day X 5 days Plasmapharesis Intravenous immunoglobulin Cyclosporin , cyclophosphamide Methylpred + IVIG
- 21. PROGNOSIS Mortality: 10% in older studies, Now <2% Morbidity: visual, motor, autonomic, and intellectual deficits and epilepsy. Problems persist after the first few weeks of illness in only about 35% of cases, and in most of these patients, the deficits resolve within 1 year of onset.
- 22. FOLLOW UP The long-term (10-y follow-up) risk of patients with ADEM for development of MS is 25%. Risk for MS is highest in children whose ADEM onset was (1) afebrile, (2) without mental status change, (3) without prodromal viral illness or immunization, (4) without generalized EEG slowing, (5) associated with an abnormal CSF immune profile