Acute Disseminated Encephalomyelitis Diagnosis in a Nine-Year-Old Girl Presenting with Neurological Symptoms Following Recent Illness

Acute disseminated encephalomyelitis (ADEM), also known as postinfectious encephalomyelitis is a rare immune-mediated pathology involving inflammatory demyelination of the central nervous system. It is shown to follow an antecedent infection or immunization in up to three-fourths of the cases.

This case report discusses a nine-year-old girl who initially presented with a one-day headache and three episodes of nonprojectile vomiting, followed by abnormal behavior, including prolonged staring and bruxism.  She experienced a brief loss of consciousness and subsequent changes in behavior, such as decreased interaction, aggressive outbursts, visual hallucinations, choreiform movements, and hemiballismus.

 There was no history of fever or other systemic symptoms, but the child had a similar episode in two months prior, which resolved with conservative treatment. The patient was immunized as per the national immunization schedule and COVID-19 vaccine (2 doses of Vero cell vaccine) was administered. 

After seeking help from traditional healers without improvement, she was brought to the emergency room. Upon examination, she was disoriented with increased muscle tone and hyperreflexia, but no signs of meningeal irritation were present. Her Glasgow Coma Scale (GCS) was 11/15.

Diagnostic imaging, including a CT scan and lumbar puncture, showed no infectious or neoplastic cause, and blood tests were found to be normal. Given the rapid onset of symptoms and multifocal CNS involvement, a demyelinating process was suspected, leading to a diagnosis of ADEM based on clinical and MRI findings.

The patient was treated with intravenous methylprednisolone, which resulted in significant improvement within three days. After a 16-day hospital stay, she was discharged with oral dexamethasone and returned for follow-up two weeks later with GCS 15/15, displaying full recovery with normal cognitive and motor function.

Thus, ADEM should be considered in children who present with prodromal symptoms followed by multifocal neurological signs. Its prompt and accurate diagnosis is essential for timely intervention to reduce neurological deficits. Early initiation of appropriate treatment is critical for positive outcomes, and achieving optimal recovery necessitates a multidisciplinary approach to care.

Source: Shrestha M, Joshi A, Pandey A, Chaudhary A, Shrestha AR, Koju N, Timilsina S, Chaudhary A. Acute Disseminated Encephalomyelitis Presenting with Neuropsychiatric Symptoms. Case Rep Pediatr. 2024 Sep 17;2024:9810844. doi: 10.1155/2024/9810844. PMID: 39319012; PMCID: PMC11421937.