Predicting the motor outcome of acute disseminated encephalomyelitis by apparent diffusion coefficient imaging: Two case reports

• Published in: Journal of the neurological sciences Vol. 280; no. 1; pp. 123 - 126
• Main Authors: Kawashima, Shoji, Matsukawa, Noriyuki, Ueki, Yoshino, Yamada, Kentaro, Sakurai, Keita, Yamawaki, Takemori, Ojika, Kosei
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 15.05.2009; Elsevier
• Subjects: ADEM; Adult; Apparent diffusion coefficient (ADC) imaging; Biological and medical sciences; Diffusion Magnetic Resonance Imaging; Encephalomyelitis, Acute Disseminated - diagnosis; Encephalomyelitis, Acute Disseminated - pathology; Humans; Internal capsule; Internal Capsule - pathology; Male; Medical sciences; Motor disturbance; Neurology; Prognosis; Tumors of the nervous system. Phacomatoses; Motor disturbance; Internal capsule; Prognosis; ADEM; Apparent diffusion coefficient (ADC) imaging; Nervous system diseases; Encephalomyelitis; Diffusion imaging; Cerebral disorder; Case study; Central nervous system disease; Diffusion coefficient; Spinal cord disease
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2009.02.358

Abstract We present two cases of young adults with acute disseminated encephalomyelitis (ADEM) who developed severe conscious and motor disturbances. Despite their similar initial clinical course and MRI findings, their motor function outcomes were quite different. In both cases, fluid attenuated inversion recovery (FLAIR) sequenced MRI showed multiple symmetric hyperintense lesions in the internal capsule and the brainstem at the subacute stage. However, in case 1 the apparent diffusion coefficient (ADC) was pathologically decreased in the internal capsule, whereas the ADC for case 2 was normal. At the end of the examination period, severe motor disability (bedridden state) with brain atrophy apparent on MRI remained in case 1, whereas case 2 made an almost full recovery without brain atrophy. These two cases suggest that altered ADC in the internal capsules at the subacute stage may reflect a different pathogenesis between cytotoxic and vasogenic edema, and may be a valuable indicator for the prognosis of motor disturbance.