Acute disseminated encephalomyelitisin the intensive care unit:clinical features and outcome of 20 adults

Abstract

Objective: Because acute disseminated encephalomyelitis (ADEM) is a rare disease in adults admitted to the intensive care unit (ICU), we describe its characteristics and patient outcomes.

Design and setting: A retrospective (2000-2006), observational, multicenter study was conducted in seven medical ICUs. Clinical, biological and neuroimaging features of patients diagnosed with ADEM were evaluated. Functional prognosis was graded using the modified Rankin (mR) scale.

Interventions: None.

Measurements and results: At ICU admission, the 20 patients' median (25th-75th percentile) Glasgow coma score (GCS) was 7 (4-13), temperature 39 (38-39) degrees C. Six (30%) patients had seizures, 17 (85%) had a motor deficit and 14 (70%) required mechanical ventilation. Fifteen (75%) patients had cerebrospinal fluid pleocytocis. All patients had white-matter lesions on their magnetic resonance images. All patients received high-dose steroids. Five (25%) patients died. Fourteen (70%) patients were able to walk without assistance (mR<or=3) at follow-up [7 (3-9) months]. Compared to the latter, patients who died or were severely disabled at the follow-up evaluation [6 (30%) patients, mR>3] had significantly lower GCS (4 (3-4) vs. 12 (7-13), p=0.002) and more frequent seizures [4 (67%) vs. 2 (14%), p=0.02] at admission.

Conclusions: Unlike previous reports, our results showed that ADEM requiring ICU admission is a severe disease causing high mortality, and 35% of the patients had persistent functional sequelae. Intensivists should be aware of ADEM's clinical features to initiate appropriate immunomodulating therapy.