Acute disseminated encephalomyelitis diagnostic study of choice: Difference between revisions

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==[[Overview]]==
==[[Overview]]==
==[[Diagnostic]] study of choice==
==[[Diagnostic]] study of choice==
[[MRI]] is the best method for further evaluation after an initial suspicion of [[ADEM]]. [[MRI]] brain with [[gadolinium]] [[enhancement]] is indicated in stable [[patients]] whereas, [[MRI]] of the [[dorsal]] and [[cervical]] [[spinal cord]] can determine the [[extent]] of [[inflammation]] in [[symptoms]] and [[signs]] suggestive of [[myelopathy]]<ref name="pmid19038851">{{cite journal| author=Callen DJ, Shroff MM, Branson HM, Li DK, Lotze T, Stephens D | display-authors=etal| title=Role of MRI in the differentiation of ADEM from MS in children. | journal=Neurology | year= 2009 | volume= 72 | issue= 11 | pages= 968-73 | pmid=19038851 | doi=10.1212/01.wnl.0000338630.20412.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038851  }} </ref>.
===[[Lesion]] features===
*[[T2-weighted]] and [[fluid-attenuated]] [[inversion]] [[recovery]] [[sequences]] typically demonstrate [[multifocal]], [[hyperintense]] [[lesions]], which vary from small, round/oval [[foci]] to [[flocculent]], "cotton-ball"[[lesions]] with fuzzy [[margins]]<ref name="pmid18987105">{{cite journal| author=Atzori M, Battistella PA, Perini P, Calabrese M, Fontanin M, Laverda AM | display-authors=etal| title=Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study. | journal=Mult Scler | year= 2009 | volume= 15 | issue= 3 | pages= 363-70 | pmid=18987105 | doi=10.1177/1352458508098562 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18987105  }} </ref>
*It can involve both [[white matter]] (WM) and [[gray matter]](GM), involvement of the former being typically [[bilateral]] and [[asymmetric]]<ref name="pmid18987105">{{cite journal| author=Atzori M, Battistella PA, Perini P, Calabrese M, Fontanin M, Laverda AM | display-authors=etal| title=Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study. | journal=Mult Scler | year= 2009 | volume= 15 | issue= 3 | pages= 363-70 | pmid=18987105 | doi=10.1177/1352458508098562 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18987105  }} </ref>
*Abnormalities are found in the [[subcortical]] and [[central]] WM, [[cortical]] GM-WM [[junction]] and deep [[GM]] of [[brainstem]], [[cerebellar]] [[thalami]] and [[basal ganglia]]<ref name="pmid18987105">{{cite journal| author=Atzori M, Battistella PA, Perini P, Calabrese M, Fontanin M, Laverda AM | display-authors=etal| title=Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study. | journal=Mult Scler | year= 2009 | volume= 15 | issue= 3 | pages= 363-70 | pmid=18987105 | doi=10.1177/1352458508098562 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18987105  }} </ref>.
*[[Pre-contrast]] [[T1-weighted]] images show a weak [[hypointensity]] only when the [[lesions]] are large in size<ref name="pmid18319160">{{cite journal| author=Rossi A| title=Imaging of acute disseminated encephalomyelitis. | journal=Neuroimaging Clin N Am | year= 2008 | volume= 18 | issue= 1 | pages= 149-61; ix | pmid=18319160 | doi=10.1016/j.nic.2007.12.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18319160  }} </ref>.
*[[Post-contrast]] [[T1-weighted]] images reveal enhancing [[lesions]] in 30-100% of patients in varying patterns (incomplete ring or arch [[enhancement]] along the edge of [[inflammation]], [[nodular]], [[gyral]] or [[spotty]] [[enhancement]])<ref name="pmid17438235">{{cite journal| author=Tenembaum S, Chitnis T, Ness J, Hahn JS, International Pediatric MS Study Group| title=Acute disseminated encephalomyelitis. | journal=Neurology | year= 2007 | volume= 68 | issue= 16 Suppl 2 | pages= S23-36 | pmid=17438235 | doi=10.1212/01.wnl.0000259404.51352.7f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17438235  }} </ref>
*[[Tumefactive]] [[lesions]] with [[horse-shoe]] shaped [[enhancement]] and [[cranial nerve]] involvement is common. However, the absence of [[enhancement]] does not exclude the diagnosis of [[ADEM]]<ref name="pmid12391351">{{cite journal| author=Tenembaum S, Chamoles N, Fejerman N| title=Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. | journal=Neurology | year= 2002 | volume= 59 | issue= 8 | pages= 1224-31 | pmid=12391351 | doi=10.1212/wnl.59.8.1224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12391351  }} </ref>.
===[[MRI]] patterns<ref name="pmid17438235">{{cite journal| author=Tenembaum S, Chitnis T, Ness J, Hahn JS, International Pediatric MS Study Group| title=Acute disseminated encephalomyelitis. | journal=Neurology | year= 2007 | volume= 68 | issue= 16 Suppl 2 | pages= S23-36 | pmid=17438235 | doi=10.1212/01.wnl.0000259404.51352.7f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17438235  }} </ref>===
*[[ADEM]] with small [[lesions]] (<5mm)
*[[ADEM]] with large, confluent, asymmetric, WM [[lesions]]
* [[ADEM]] with symmetric, bithalamic involvement
*[[ADEM]] with [[acute]], [[hemorrhagic]] [[encephalomyelitis]]
===Evolution of [[lesions]]===
*Despite the absence of specific criteria, especially for children<ref name="pmid15289266">{{cite journal| author=Mikaeloff Y, Adamsbaum C, Husson B, Vallée L, Ponsot G, Confavreux C | display-authors=etal| title=MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood. | journal=Brain | year= 2004 | volume= 127 | issue= Pt 9 | pages= 1942-7 | pmid=15289266 | doi=10.1093/brain/awh218 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289266  }} </ref>, follow up [[MRI]] scans at intervals no lesser than six months help establish or confirm the [[diagnosis]] of [[ADEM]]. The [[lesions]] should resolve or remain unchanged<ref name="pmid2328406">{{cite journal| author=Kesselring J, Miller DH, Robb SA, Kendall BE, Moseley IF, Kingsley D | display-authors=etal| title=Acute disseminated encephalomyelitis. MRI findings and the distinction from multiple sclerosis. | journal=Brain | year= 1990 | volume= 113 ( Pt 2) | issue=  | pages= 291-302 | pmid=2328406 | doi=10.1093/brain/113.2.291 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2328406  }} </ref>.
*Persistent [[hypointense]] [[WM]] [[lesions]] are infrequent in [[ADEM]]<ref name="pmid23572237">{{cite journal| author=Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC | display-authors=etal| title=International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. | journal=Mult Scler | year= 2013 | volume= 19 | issue= 10 | pages= 1261-7 | pmid=23572237 | doi=10.1177/1352458513484547 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23572237  }} </ref>.

Revision as of 07:20, 19 November 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

Diagnostic study of choice

MRI is the best method for further evaluation after an initial suspicion of ADEM. MRI brain with gadolinium enhancement is indicated in stable patients whereas, MRI of the dorsal and cervical spinal cord can determine the extent of inflammation in symptoms and signs suggestive of myelopathy[1].

Lesion features

MRI patterns[4]

Evolution of lesions

  • Despite the absence of specific criteria, especially for children[6], follow up MRI scans at intervals no lesser than six months help establish or confirm the diagnosis of ADEM. The lesions should resolve or remain unchanged[7].
  • Persistent hypointense WM lesions are infrequent in ADEM[8].
  1. ↑ Callen DJ, Shroff MM, Branson HM, Li DK, Lotze T, Stephens D; et al. (2009). "Role of MRI in the differentiation of ADEM from MS in children". Neurology. 72 (11): 968–73. doi:10.1212/01.wnl.0000338630.20412.45. PMID 19038851.
  2. ↑ 2.0 2.1 2.2 Atzori M, Battistella PA, Perini P, Calabrese M, Fontanin M, Laverda AM; et al. (2009). "Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study". Mult Scler. 15 (3): 363–70. doi:10.1177/1352458508098562. PMID 18987105.
  3. ↑ Rossi A (2008). "Imaging of acute disseminated encephalomyelitis". Neuroimaging Clin N Am. 18 (1): 149–61, ix. doi:10.1016/j.nic.2007.12.007. PMID 18319160.
  4. ↑ 4.0 4.1 Tenembaum S, Chitnis T, Ness J, Hahn JS, International Pediatric MS Study Group (2007). "Acute disseminated encephalomyelitis". Neurology. 68 (16 Suppl 2): S23–36. doi:10.1212/01.wnl.0000259404.51352.7f. PMID 17438235.
  5. ↑ Tenembaum S, Chamoles N, Fejerman N (2002). "Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients". Neurology. 59 (8): 1224–31. doi:10.1212/wnl.59.8.1224. PMID 12391351.
  6. ↑ Mikaeloff Y, Adamsbaum C, Husson B, Vallée L, Ponsot G, Confavreux C; et al. (2004). "MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood". Brain. 127 (Pt 9): 1942–7. doi:10.1093/brain/awh218. PMID 15289266.
  7. ↑ Kesselring J, Miller DH, Robb SA, Kendall BE, Moseley IF, Kingsley D; et al. (1990). "Acute disseminated encephalomyelitis. MRI findings and the distinction from multiple sclerosis". Brain. 113 ( Pt 2): 291–302. doi:10.1093/brain/113.2.291. PMID 2328406.
  8. ↑ Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC; et al. (2013). "International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions". Mult Scler. 19 (10): 1261–7. doi:10.1177/1352458513484547. PMID 23572237.
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