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 Case Reports |
| A Case of recurrent Acute Disseminated Encephalomyelitis |
| Yong Ho Kim, Kyung Yil Lee, Ji Whan Han, Sung Soo Hwang, Kyong Su Lee |
| Department of Pediatrics, Catholic University Medical College, Seoul, Korea |
Vol.13 Num.2 (p189~195)
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Acute disseminated encephalomyelitis(ADEM) is an acute inflammatory demyelinating disease of the central nervous system. We experienced a case of recurrent ADEM in a 38 month-old boy who showed weakness of the lower extremities twice in 1 year interval(first attack after MMR vaccination; second attack after JBE vaccination). Brain magnetic resonance imaging(MRI) on first admission demonstrated multiple nodular gyriform high signal intensity(SI) in the bilateral thalamus, and subcortical white matter with gadolinium-DTPA enhancing basal ganglia.. This boy recovered with prednisone therapy within 20days and he remained relatively good health for 1 year. 1 month before second admission, he received JBE vaccination 2 times 1 week interval. At this time brain MRI demonstrated also much dissemination of the high SI foci in most of brain parenchyme, and with the relatively same area and nature as the MRI before 1 year. Follow-up brain MRI after 3 months demonstrated a markded atrophic change of brain parenchyme with enlargement of ventricles and cisterns, but lesions in bilateral basal ganglia were still remained. The level of IgG in the cerebrospinal fluid was not elevated and olygoclonal band was not found. Despite various treatment including methylprednisolone pulse therapy, his neurologic symptoms progressively aggrevated and finally he died 3 months later.
We report the case of 38 month-old boy with recurrent weakness of lower extremities, who was diagnosed as recurrent ADEM with clinical course and serial MRI.
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Keywords : Acute Disseminated Encephalomyelitis(ADEM), Magnetic Resornance Imaging(MRI) |
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