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1503 Acute Disseminated Encephalomyelitis in Children (Eight Cases Reports)

Background Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory disorder of the central nervous system, characterized by a widespread demyelination that predominantly involves the white matter of the brain and spinal cord. We aimed to assess the clinical presentations, neuroimaging, treatment, and outcome of eight children with ADEM. Methods An 11-years retrospective chart review of children with the diagnosis of ADEM was conducted during the period between 2000 and 2011. The diagnosis of ADEM was carried in front of clinical and radiological signs. Results Eight cases of ADEM, aged between 9 months and 14 years, were identified. The clinical picture is characterized by multiple symptoms. Prominent findings are seizures in three cases, altered level of consciousness in seven cases and motor system dysfunction in five cases. Brain magnetic resonance imaging evaluations had done in all patients and revealed demyelinated lesions in the cerebral cortex, subcortical white matter, in periventricular white matter, in deep gray matter and in brainstem in all patients. Spinal cord MRI was performed in one case and showed demyelinated lesions in cervical and dorsal etage. All patients were treated with high-dose intravenous methylprednisolone pulse therapy during six days, related by oral corticotherapy. Five of them received also intravenous immunoglobulins. The evolution was favorable in all patients, only one had mild long-term optic neuritis sequelae. Conclusion Clinical features of ADEM are similar to those of infectious encephalitis. The neuroimaging test of choice to establish the diagnosis is MRI. In most patients, the prognosis is good after treatment.