Acute Disseminated Encephalomyelitis with Psychotic and Parkinsonian Features: A Case Report.
- Author:
Eunhee SHIM
1
;
Mi Sun YUM
;
Eun Hee KIM
;
Hae Won CHOI
;
Tae Sung KO
Author Information
1. Department of Pediatrics, Children's Hospital, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. tsko@amc.seoul.kr
- Publication Type:Case Report
- Keywords:
Acute disseminated encephalomyelitis;
Psychosis;
Parkinsonian disorder;
Enterovirus
- MeSH:
Adolescent;
Antipsychotic Agents;
Basal Ganglia;
Brain;
Cerebrospinal Fluid;
Coma;
Delirium;
Delusions;
Demyelinating Diseases;
Encephalomyelitis, Acute Disseminated*;
Enterovirus;
Follow-Up Studies;
Hippocampus;
Humans;
Hypokinesia;
Immunization;
Magnetic Resonance Imaging;
Male;
Methylprednisolone;
Neurologic Manifestations;
Polymerase Chain Reaction;
Psychotic Disorders;
Respiratory Tract Infections;
Tremor
- From:
Journal of the Korean Child Neurology Society
2013;21(3):176-183
- CountryRepublic of Korea
- Language:English
-
Abstract:
Acute disseminated encephalomyelitis (ADEM) is a monophasic immune-mediated demyelination disorder that can arise following infection or immunization. Typical MRI findings show multifocal demyelinating lesions in the CNS. The presenting features include acute encephalopathy with multifocal neurologic signs, and patients often progress to develop delirium and/or coma, but acute psychosis is rare. In our current report, we describe a case of a 14-year-old boy presenting with parkinsonian features (masked face, bradykinesia, resting tremor, slow strides) as well as aggressive behavior and irritability with persecutory delusions that developed 3 days after an upper respiratory tract infection. T2-weighted/FLAIR brain MRI showed increased signal intensity in the hippocampus and basal ganglia including in the caudate nuclei. Cerebrospinal fluid (CSF) enterovirus PCR was positive. After treatment with high-dose methylprednisolone and antipsychotics, he recovered without permanent disabilities, and the initial lesions found on MRI disappeared on follow-up.
