NEUROLOGY AND NEUROSURGERY - Y. V. ALEKSEENKO - 2014

ACUTE DISSEMINATED ENCEPHALOMYELITIS

Acute disseminated encephalomyelitis (ADEM) is an infectious-allergic disease of The Nervous system, presumably triggered by a neurotropic virus. Immune disorders and altered Blood-Brain barrier permeability play a critical role in the Pathogenesis of the disease. This condition is characterized by multiple inflammatory lesions in the BRAIN AND SPINAL cord, with a predominance of White matter involvement and demyelination of nerve fibers. Unlike multiple sclerosis, ADEM presents as a single exacerbation period and does not follow a relapsing-remitting course.

Most often, the disease has an acute onset, presenting with a combination of general infectious, generalized cerebral, meningeal, and focal symptoms. The widespread focal lesions in the WHITE MATTER OF the brain and Spinal Cord manifest as visual disturbances, oculomotor deficits, impaired innervation of facial Muscles, and bulbar disorders. Paresis and paralysis of the limb muscles are frequently observed, predominantly of the upper motor neuron (central) type. Coordination disorders are quite common, and pelvic organ dysfunction may also occur. Analysis of the CEREBROSPINAL FLUID reveals a slight increase in lymphocyte count (20-100 per 1 mm³). The clinical course of ADEM is characterized by the rapid development of systemic infectious and neurological symptoms, followed by a gradual regression of the deficits. The prognosis is generally favorable, although the recovery may be incomplete. Treatment of ADEM involves the administration of corticosteroids, plasmapheresis, courses of metabolic and vasoregulatory agents, and symptomatic therapy.

Clinical Cases

Case 1

A 24-year-old man presents with lower extremity weakness, unsteadiness when walking, difficulty urinating, and double Vision that worsens when looking to the left. These symptoms developed gradually without an apparent cause and have persisted to the same degree for about a month. Two years ago, following a cold, he experienced blurred vision primarily in the left eye, which resolved spontaneously within two weeks without treatment. Several months ago, after overexertion, he experienced a brief episode of leg weakness and unsteadiness of gait. Examination reveals horizontal nystagmus, which increases upon lateral gaze. Speech is uneven, with abnormal stress placement across sentences. There is a slight decrease in Muscle strength in the legs. Tendon Reflexes are hyperactive in both upper and lower extremities. Ankle clonus and a bilateral Babinski sign are present. Abdominal reflexes are diminished. There are no distinct sensory deficits. Coordination testing reveals significant past-pointing and intention tremor bilaterally. Romberg's test shows instability. He notes that his condition worsens after a hot bath or heat exposure—lower limb weakness and gait unsteadiness increase.

   • List the main neurological disorders.

   • Determine The Nature of the motor impairments.

   • Determine the Nature of the coordination disorders.

   • How should the speech abnormalities be interpreted?

   • How can the visual disturbances be explained?

   • How can the urinary dysfunction be interpreted?

   • Identify the leading neurological syndrome.

   • Formulate the topographic Diagnosis.

   • Formulate the preliminary clinical diagnosis.

   • Explain THE ORIGIN OF this clinical form's name.

   • Determine the nature of the pathological process underlying the disease.

   • Explain The Significance of the medical history details.

   • List the diagnostic criteria for this nosological entity.

   • Outline the Differential diagnosis.

   • Name the required Instrumental Diagnostic Methods and their purpose.

   • List the most common potential causes of gait disturbance.

   • What are the epidemiological and geographical features of multiple sclerosis?

   • List the main clinical forms and types of disease progression.

  • Name the Main Components of drug therapy.

  • What treatment methods are most effective during an acute exacerbation of the disease?

  • Determine the prognosis of the disease.