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 in | Journal of neurology, neurosurgery and psychiatry Vol. 85; no. 7; pp. 820 - 822 |
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| Main Authors | , |
| Format | Journal Article |
| Language | English |
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England
BMJ Publishing Group LTD
01.07.2014
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| Abstract | 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 |
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| AbstractList | 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 |
| Author | Wardman, D L Zagami, A S |
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| Cites_doi | 10.1212/01.wnl.0000179302.93960.ad 10.1016/j.jneuroim.2010.09.019 10.1097/WCO.0b013e3280f31b45 10.1097/WCO.0b013e32833925ec 10.1016/j.jns.2011.03.028 |
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| References | Wender 2011; 231 Palace 2011; 306 Sonneville, Klein, Wolff 2010; 223 Menge, Kieseier, Nessler 2007; 20 Marchioni, Ravaglia, Piccolo 2005; 65 Sonneville (key-10.1136/jnnp-2013-306093-5) 2010; 223 Wender (key-10.1136/jnnp-2013-306093-1) 2011; 231 Palace (key-10.1136/jnnp-2013-306093-3) 2011; 306 Menge (key-10.1136/jnnp-2013-306093-2) 2007; 20 Marchioni (key-10.1136/jnnp-2013-306093-4) 2005; 65 |
| References_xml | – volume: 223 start-page: 300 year: 2010 article-title: Update on investigation & management of postinfectious encephalitis publication-title: Curr Opin Neurol contributor: fullname: Wolff – volume: 20 start-page: 247 year: 2007 article-title: Acute disseminated encephalomyelitis: an acute hit against the brain publication-title: Curr Opin Neurol contributor: fullname: Nessler – volume: 306 start-page: 188 year: 2011 article-title: Acute disseminated encephalomyelitis and its place amongst other acute inflammatory demyelinating CNS disorders publication-title: J Neurol Sci contributor: fullname: Palace – volume: 231 start-page: 92 year: 2011 article-title: Acute disseminated encephalomyelitis (ADEM) publication-title: J Neuroimmunol contributor: fullname: Wender – volume: 65 start-page: 1057 year: 2005 article-title: Post infectious inflammatory disorders. Subgroups based on prospective followup publication-title: Neurology contributor: fullname: Piccolo – volume: 65 start-page: 1057 year: 2005 ident: key-10.1136/jnnp-2013-306093-4 article-title: Post infectious inflammatory disorders. Subgroups based on prospective followup publication-title: Neurology doi: 10.1212/01.wnl.0000179302.93960.ad contributor: fullname: Marchioni – volume: 231 start-page: 92 year: 2011 ident: key-10.1136/jnnp-2013-306093-1 article-title: Acute disseminated encephalomyelitis (ADEM) publication-title: J Neuroimmunol doi: 10.1016/j.jneuroim.2010.09.019 contributor: fullname: Wender – volume: 20 start-page: 247 year: 2007 ident: key-10.1136/jnnp-2013-306093-2 article-title: Acute disseminated encephalomyelitis: an acute hit against the brain publication-title: Curr Opin Neurol doi: 10.1097/WCO.0b013e3280f31b45 contributor: fullname: Menge – volume: 223 start-page: 300 year: 2010 ident: key-10.1136/jnnp-2013-306093-5 article-title: Update on investigation & management of postinfectious encephalitis publication-title: Curr Opin Neurol doi: 10.1097/WCO.0b013e32833925ec contributor: fullname: Sonneville – volume: 306 start-page: 188 year: 2011 ident: key-10.1136/jnnp-2013-306093-3 article-title: Acute disseminated encephalomyelitis and its place amongst other acute inflammatory demyelinating CNS disorders publication-title: J Neurol Sci doi: 10.1016/j.jns.2011.03.028 contributor: fullname: Palace |
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| Snippet | Discussion The most likely diagnosis is acute disseminated encephalomyelitis (ADEM), given the rapid, severe, simultaneous bilateral visual loss, the preceding... |
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| SubjectTerms | 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 |
| Title | Acute bilateral visual loss in a young adult |
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