Recurrent Acute Disseminated Encephalomyelitis Presenting as Conus Medullaris Syndrome: A Case Report.
Dae-Wook LeeSeok KangNack Hwan KimPublished in: Medicina (Kaunas, Lithuania) (2024)
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that typically follows an infection or recent vaccination. Symptoms such as encephalopathy and focal neurological deficits appear weeks after the initial illness, leading to swift and progressive neurological decline. While ADEM in the brain has been well documented, reports of ADEM, specifically in the spinal cord, are relatively limited. A 58-year-old male presented with rapidly progressive bilateral lower extremity tingling, numbness, and mild gait disturbance approximately two days prior to visiting the emergency room. Spinal magnetic resonance imaging revealed a diffuse, longitudinal, high-signal lesion with mild enlargement of the conus and proximal cauda equina. The lesions were predominantly localized in the distal conus and cauda equina, and serial electrodiagnostic studies showed that the lesions progressed toward the proximal conus in tandem with symptom evolution and lacked clear lateralization. The patient was subsequently treated with high-dose steroids for seven days (intravenous methylprednisolone, 1 mg/kg). The patient's lower extremity weakness gradually improved and he was able to walk independently under supervision three weeks after symptom onset. In this case of spinal ADEM in a middle-aged adult, high-dose steroid treatment led to outstanding neurological recovery from both the initial occurrence and subsequent attacks.
Keyphrases
- high dose
- spinal cord
- case report
- liver failure
- low dose
- stem cell transplantation
- magnetic resonance imaging
- middle aged
- multiple sclerosis
- respiratory failure
- cerebral ischemia
- drug induced
- emergency department
- spinal cord injury
- neuropathic pain
- traumatic brain injury
- healthcare
- risk assessment
- public health
- gestational age
- white matter
- computed tomography
- hepatitis b virus
- resting state
- single cell
- minimally invasive
- adverse drug
- patient reported
- preterm birth
- extracorporeal membrane oxygenation
- newly diagnosed
- depressive symptoms
- cerebral palsy
- sleep quality
- high grade