Clinical-evolutive particularities and therapeutic-rehabilitative approach in the rare case of acute disseminated encephalomyelitis following an episode of viral meningitis of unknown etiology

Abstract

Acute disseminated encephalomyelitis (ADEM) is a disease mainly affecting children, however, adult cases have been also reported. The disease represents a demyelinating disorder of the central nervous system, with a monophasic evolution and mostly full recovery. Mortality is documented at only 2%, but there are risks of complications in the acute phase, mostly due to the vast number of lesions and their distribution in the cerebrum. We present the case of a 40 year-old female patient who presented with visual impairment, coordination issues with walking difficulties, hypoesthesia of the entire body, back and upper limbs paresthesia, upper limbs and torso tremor as well as speech impairment. Symptoms appeared on the same day after discharge from the Infectious Disease Hospital where she was treated for viral meningitis. MRI findings on admission described multiple demyelinating lesions located bilaterally in the white matter and in the cervical spine. The patient was started on high dose parenteral methylprednisolone 1g/day for 5 days and afterwards was switched to oral corticoids with dose tapering over a period of 40 days. Rehabilitation treatment was started during hospitalization and continued after discharge. Evolution was favorable, with almost complete recovery, the patient presenting with only minor hypoesthesia of the torso at discharge. Key words: acute disseminated encephalomyelitis, ADEM, meningitis, rehabilitation,