ADEM

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By: blacknkhack (59 month(s) ago)

Wow, scary and hope inspired. I like it.

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What does this specimen Show? : 

What does this specimen Show? Optic Nerve Stained for Myelin.

7yr. male VP from Jamnagar : 

7yr. male VP from Jamnagar Left sided seizures – 2 episodes Referred for EEG from Jamnagar. Pt started on CBZ, not ready for MRI After 2 wks referred from opthalmologist for loss of vision, and optic neuritis MRI done- Diagnosis ADEM

ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) - A Clinical and Neuroradiological Profile of Pediatric Patients. : 

ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) - A Clinical and Neuroradiological Profile of Pediatric Patients. Presented By Dr Jaimin M Patel M.D.(Paed) Under guidance of Dr.Varsha Tripathi M.D.(Paed),MRCP(London) Paediatric Neurologist With the help of Dr Manisha Shah. D. C. H.

Case History: ADEM : 

Case History: ADEM 4 year old male child URTI for 3-4 days Admitted with convulsions altered sensorium aphasia left hemiparesis CSF prt: 72 mg/dL (40-60) cells: 8 cells/mm3 MRI scan:(T2 weighted)asymmetrical hyper intensities in midbrain (more on right side) and middle cerebral peduncle suggestive of ADEM.

Case History: ADEM : 

Case History: ADEM Symptomatic treatment IV methylprednisolone givenafter 48 hours no improvement- some deteriorationRt.third nerve palsybulbar weakness IVIG given 1gm/kg/day for 2 daysRyles tube feeding started5 th day onwards improvement started child was hospitalized for 17 days At present child completely normal, going to school

ADEM- Acute Disseminated Encephalomyelitis : 

ADEM- Acute Disseminated Encephalomyelitis Acute-Disseminated-Encephalo-Myelo-Itis (ADEM) Usually monophasic Demyelinating disorder Characterized by diffuse neurologic signs and symptoms (polysymptomatic) Nuroimaging- multifocal lesions of demyelination

Study… : 

Study… Retrospective Study Period : 14 months from Aug 2003 to Nov 2004 Study Place: Medisurge and Sterling H. Total No of Pts –13 Mean Age – 4. 02 yrs. M : F = 9 : 4

Clinical Features & Complains : 

Clinical Features & Complains

Neurological Examination. : 

Neurological Examination.

ADEM : Investigations : 

ADEM : Investigations CSF (9 available) – 6 (66%) –normal, 3- (33%) Increase Pr. 1 (11%) -Pleocytosis Mild mononuclear pleocytosis, raised proteins MBP content increased in 60% intrathecal oligoclonal immunoglobulins and IgG seen occasionally CT Scan: (1 Pt-B/L hypodensities) (NOT INDICATED) May be normal or may reveal areas of patchy low attenuation in the white matter.

MRI Scan : 

MRI Scan R

ADEM : Investigations : 

ADEM : Investigations MRI scan brain: Multiple foci of demyelination in the cerebrum, midbrain, brain stem and cerebellum Lesions are rather extensive and symmetric or asymmetric and more often located in the peripheral subcortical cerebral white matter. Lesions in the thalami, hypothalamus and basal ganglia Occasionally there can be cortical grey mater involvement also

MRI : 

MRI

ADEM: Treatment : 

ADEM: Treatment High Dose Steroids High dose IV Methyl Prednisolone 30 mg/kg/day for 3-5 days followed by oral steroids (Prednisoslone) for 6 weeks IVIG (<1 yr, No improvement in 48-72 hrs , AHLE, Recurrent) 1 gm/kg/day iv for 2 days Plasmapheresis Symptomatic Rx

Treatment. : 

Treatment.

Relapse : 

Relapse Usually a monophasic illness Multiphasic disseminated encephalomyelitis MDEM (Two in my study) Recurrences : defined as appearance of new s/s at least 1 mth. after the previous episode. 10-20% in different studies (2=15% in my study) Recurrence appeared 1.5 - 32 months after initial presentation, but usually after steroids were stopped (2 months in my study) 6 week taper shows less recurrences

PROGNOSIS : 

PROGNOSIS Complete recovery in 10 (77%) of the survivors Relapsing disease in 2 (15%) Mortality in 1 (7.6%) case. (Post Measles)

Thank You : 

Thank You