Annals of Indian Academy of Neurology
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Year : 2004  |  Volume : 7  |  Issue : 4  |  Page : 501-506

Clinical Spectrum Of Acute Disseminated Encephalo Myelitis In Relation To Aetiology And Neuroimaging Study



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K Das


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Background: Acute disseminated Encephalo Myelitis (ADEM) is an important neurological cause of mortality and morbidity and many aspects of the aetiopathogenesis and clinical presentation are still not clear. More studies are needed to be continued particularly from developing countries on ADEM. Aims & Objects: To study the clinical spectrum of ADEM in relation to aetiology and neuroimaging study and to compare the findings observed in the other parts of India and abroad. Materials and Methods: Clinical examinations, neuroimaging study and electrophysiological tests and follow up in 62 patients of ADEM in the Bangur Institute of Neurology, Kolkata, India from January 1996 to March 2004. Results: Thirty Four patients (54.83%) were below 20 years. Among the preceding events, presumptive viral infections accounted for 32.25% of the total cases, specific viral infections in 43.54% cases, and sample antirabies vaccinations in 24.19% cases. Myeloradiculitis were the common neuroparalytic complications following semple anti rabies vaccination found in 10 patients and in another 5 post vaccinated patients had multiple sites of involvement. Acute cerebellar ataxia was the common clinical presentation following varicella infection found in 8 cases and another 6 cases had multiple sites involvement. Multimodal evoked potential studies corresponds to the clinical localization of lesions. MRI studies disclosed that white matter lesions were maximum in subcortical white matter and periventricular regions. No signal alterations were observed in 4 cases of acute cerebellar ataxia following varicellar infection and 4 cases of Myeloradiculitis following semple anti rabies vaccinations. Out of 62 patients, 50 patients survived (80.64%), among them 22 patients (44%) had significant motor disability and rest 28 (56%) recovered well in the functional status. Mortality found in the study was in 12 patients (19.36%). Conclusion: Specific viral infections is the common preceding events of ADEM followed by presumptive viral and survivors had motor disability in the 44% cases. The outcome was greatly influenced by antecedent events and number of sites of involvement.


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