Acute bilateral visual loss in a young adult

Discussion The most likely diagnosis is acute disseminated encephalomyelitis (ADEM), given the rapid, severe, simultaneous bilateral visual loss, the preceding viral infection and the appearance and distribution of MRI lesions. ADEM is a parainfectious or postinfectious autoimmune demyelinating dise...

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Published inJournal of neurology, neurosurgery and psychiatry Vol. 85; no. 7; pp. 820 - 822
Main Authors Wardman, D L, Zagami, A S
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.07.2014
Subjects
Aquaporins
Blindness - etiology
Blindness - pathology
Brain - pathology
Encephalomyelitis, Acute Disseminated - complications
Encephalomyelitis, Acute Disseminated - diagnosis
Encephalomyelitis, Acute Disseminated - pathology
Fundus Oculi
Humans
Magnetic Resonance Imaging
Neuroimaging
Spinal cord
Visual Field Tests
Young Adult
Young adults
MULTIPLE SCLEROSIS
VISION
HEADACHE
MRI
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Summary:Discussion The most likely diagnosis is acute disseminated encephalomyelitis (ADEM), given the rapid, severe, simultaneous bilateral visual loss, the preceding viral infection and the appearance and distribution of MRI lesions. ADEM is a parainfectious or postinfectious autoimmune demyelinating disease of the CNS and has been considered a monophasic illness, though multiphasic ADEM has been reported. 1 The highest incidence of ADEM is observed during childhood. 2 3 The clinical spectrum of ADEM is heterogeneous with upper motor neuron signs (78%), encephalopathy (42%), meningeal reaction (27%) and cranial neuropathy (17%) but symmetrical visual loss (12%) is less common. 4 Intravenous corticosteroids are the mainstay of initial therapy though immunoglobulin and plasmapheresis have been used in steroid refractory ADEM. 5
Bibliography:ObjectType-Case Study-2
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ISSN:0022-3050
1468-330X
DOI:10.1136/jnnp-2013-306093