dalila boumendil

Abstract:

Introduction: Acute disseminated encephalomyelitis (ADEM) is a demyelinating central nervous system disorder. The experience of children in our area is limited.

Purpose: We describe a cohort of consecutive children with ADEM.

Methods: Clinical and MRI of brain characteristics, treatment, and outcome of a series of ADEM hospitalized in PICU, Oran University Hospital center (Algeria) from January 2011 to May 2016 were reviewed.

Results: There were 07 males and 03 females. The mean age (median) at onset was 48 months [range, 6 –132 months]. All children had a prodromal event (infectious 08 cases or vaccination 02 cases). The mean interval between the febrile prodrome and the beginning of neurologic disturbance was 14 days (range, 3 to 30 days). Limb weakness (02 cases), ataxia (02 cases), ophthalmoplegia (02 cases), and acute hemiparesis (02 cases) were the most prominent initial findings. Aphasia was noticed in one patient. the Seizure was observed in 07 patients. Consciousness disturbance (n=5) evolved into a coma with cardiomyopathy of stress in one patient. CSF lymphocyte pleocytosis was found in 3 patients (9 – 208 cells/mm3). Initial MRI showed a deep gray matter involvement in 6 cases. Electroencephalogram (EEG) showed slowing of background activity in 04 patients. 05 patients were treated with IV immunoglobulin alone and 03 with high-dose IV methylprednisolone pulse. Among 10 patients, five had long-term neurological squeals.

Conclusion: We conclude that early diagnosis and prompt treatment of ADEM will probably reduce morbidity and the seizures are not uncommon in ADEM.

Keywords: Encephalopathy, ADEM, Brain Magnetic Resonance Imaging, Children, Outcome.