Medical and Surgical Management of Acute Disseminated Encephalomyelitis

• Published in: Journal of neuro-ophthalmology Vol. 14; no. 4; pp. 210 - 213
• Main Authors: Ellis, Brian D, Kosmorsky, Gregory S, Cohen, Bruce H
• Format: Journal Article
• Language: English
• Published: United States Williams & Wilkins 01.12.1994
• Subjects: Brain - pathology; Child, Preschool; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Encephalomyelitis, Acute Disseminated - diagnosis; Encephalomyelitis, Acute Disseminated - therapy; Encephalomyelitis, Acute Disseminated - virology; Female; Humans; Magnetic Resonance Imaging; Optic Neuritis - diagnosis; Optic Neuritis - therapy; Optic Neuritis - virology; Ventriculoperitoneal Shunt; Virus Diseases - complications; Vision Disorders - etiology
• ISSN: 1070-8022; 1536-5166
• DOI: 10.1097/00041327-199412000-00006

Two children with a recent history of viral illness developed visual loss secondary to optic neuritis. Clinical findings and neuroimaging were consistent with acute disseminated encephalomyelitis (ADEM). Markedly elevated opening pressures were noted on lumbar puncture. The patients demonstrated an initial favorable response to high-dose corticosteroid administration. Both had recurrence of symptoms after being tapered off oral corticosteroids. High-dose corticosteroids were reinstituted and a bilateral optic nerve sheath decompression was performed on one patient who developed profound visual loss. A second patient underwent a lumboperitoneal shunt. Both children had resolution of their symptoms and had a recovery of normal visual acuity.