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      Acute disseminated encephalomyelitis associated with hepatitis B virus reinfection – Consequence or coincidence?

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          Abstract

          Acute disseminated encephalomyelitis (ADEM) is an idiopathic inflammatory demyelinating disease of the CNS that is particularly difficult to differentiate from the first episode of multiple sclerosis. ADEM typically occurs as a post-infectious phenomenon, and usually presents a monophasic episode, but also includes recurrent and multiphasic forms. We report a case of ADEM associated with hepatitis B virus (HBV) reinfection. After steroid and IV immunoglobulin treatment, neurologic symptoms were improved. We suppose that the HBV reinfection was the cause of ADEM, but possible pathogenetic mechanism is still obscure.

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          Acute disseminated encephalomyelitis.

          Silvia Tenembaum, , Tanuja Chitnis … (2007)
          Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory disorder of the CNS characterized by a widespread demyelination that predominantly involves the white matter of the brain and spinal cord. The condition is usually precipitated by a viral infection or vaccination. The presenting features include an acute encephalopathy with multifocal neurologic signs and deficits. Children are preferentially affected. In the absence of specific biologic markers, the diagnosis of ADEM is still based on the clinical and radiologic features. Although ADEM usually has a monophasic course, recurrent or multiphasic forms have been reported, raising diagnostic difficulties in distinguishing these cases from multiple sclerosis (MS). The International Pediatric MS Study Group proposes uniform definitions for ADEM and its variants. We discuss some of the difficulties in the interpretation of available literature due to the different terms and definitions used. In addition, this review summarizes current knowledge of the main aspects of ADEM, including its clinical and radiologic diagnostic features, epidemiology, pathogenesis, and outcome. An overview of ADEM treatment in children is provided. Finally, the controversies surrounding pediatric MS and ADEM are addressed.
          Article 0 comments Cited 159 times – based on 0 reviews     Review now
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            Consensus definitions proposed for pediatric multiple sclerosis and related disorders.

            Silvia Tenembaum, Brenda Banwell, … (2007)
            The CNS inflammatory demyelinating disorders of childhood include both self-limited and lifelong conditions, which can be indistinguishable at the time of initial presentation. Clinical, biologic, and radiographic delineation of the various monophasic and chronic childhood demyelinating disorders requires an operational classification system to facilitate prospective research studies. The National Multiple Sclerosis Society (NMSS) organized an International Pediatric MS Study Group (Study Group) composed of adult and pediatric neurologists and experts in genetics, epidemiology, neuropsychology, nursing, and immunology. The group met several times to develop consensus definitions regarding the major CNS inflammatory demyelinating disorders of children and adolescents. Clinical definitions are proposed for pediatric multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), recurrent ADEM, multiphasic ADEM, neuromyelitis optica, and clinically isolated syndrome. These definitions are considered operational and need to be tested in future research and modified accordingly. CNS inflammatory demyelinating disorders presenting in children and adolescents can be defined and distinguished. However, prospective research is necessary to determine the validity and utility of the proposed diagnostic categories.
            Article 0 comments Cited 137 times – based on 0 reviews     Review now
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              Acute disseminated encephalomyelitis: an update.

              Olaf Stuve, Heinz Wiendl, Bernhard Hemmer … (2005)
              Acute disseminated encephalomyelitis (ADEM) is a monophasic autoimmune demyelinating disease of the central nervous system that typically follows a febrile infection or a vaccination. Children are predominantly affected. A plethora of viral and bacterial pathogens and a number of vaccinations have been associated with ADEM. Experimental animal studies indicate that both primary and secondary autoimmune responses contribute to central nervous system inflammation and subsequent demyelination. The clinical diagnosis of ADEM is strongly suggested by a close temporal relationship between an infectious incident or an immunization and the onset of leukoencephalopathic neurological symptoms. Paraclinical tests may support the diagnosis. Particularly helpful are acute signs of newly developed extensive, multifocal, subcortical white matter abnormalities on magnetic resonance images of the brain. The cerebrospinal fluid may disclose a mild lymphocytic pleocytosis and elevated albumin levels. Oligoclonal bands are not always present in ADEM and, if so, may be transient. The major differential diagnosis of ADEM is multiple sclerosis. Treatment options for ADEM consist of anti-inflammatory and immunosuppressive agents. In general, the disease is self-limiting and the prognostic outcome favorable. In the absence of widely accepted clinical or paraclinical diagnostic guidelines, a number of recently conducted observational case series have substantially broadened our understanding about the clinical phenotype, diagnosis, and prognosis of ADEM.
              Article 0 comments Cited 87 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ines Lazibat
                Journal
                Journal ID (nlm-ta): Clin Neurol Neurosurg
                Journal ID (iso-abbrev): Clin Neurol Neurosurg
                Title: Clinical Neurology and Neurosurgery
                Publisher: Elsevier B.V.
                ISSN (Print): 0303-8467
                ISSN (Electronic): 1872-6968
                Publication date PMC-release: 8 December 2013
                Publication date (Print): December 2013
                Publication date (Electronic): 8 December 2013
                Volume: 115
                Pages: S35-S37
                Affiliations
                [a ]University of Zagreb, Dubrava University Hospital, Department of Neurology, Zagreb, Croatia
                [b ]School of Medicine University of Zagreb, Association for MS Research Zagreb, Zagreb, Croatia
                Author notes
                [* ]Corresponding author. Tel.: +385 91 40 99 664. ilazibat@ 123456kbd.hr
                Article
                Publisher ID: S0303-8467(13)00372-7
                DOI: 10.1016/j.clineuro.2013.09.018
                PMC ID: 7116977
                PubMed ID: 24321152
                SO-VID: 2d2aec95-f9f4-46af-a9e0-0db7f7a2c399
                Copyright statement: Copyright © 2013 Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Article

                ScienceOpen disciplines: Surgery
                Keywords: acute disseminated encephalomyelitis (adem),hepatitis b virus (hbv),recurrent and multiphasic forms of dem
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: acute disseminated encephalomyelitis (adem), hepatitis b virus (hbv), recurrent and multiphasic forms of dem

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