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Case Reports
. 2019 Sep;9(9):e01374.
doi: 10.1002/brb3.1374. Epub 2019 Jul 25.

Acute disseminated encephalomyelitis following varicella-zoster virus infection: Case report of effective treated both in clinical symptom and neuroimaging

Qi Wang  1 , Li-Na Cai  1 , Xiang-Qing Wang  2
Affiliations
Case Reports

Acute disseminated encephalomyelitis following varicella-zoster virus infection: Case report of effective treated both in clinical symptom and neuroimaging

Qi Wang et al. Brain Behav. 2019 Sep.

Abstract

Introduction: Acute disseminated encephalomyelitis (ADEM) is an idiopathic inflammatory demyelinating disorder of the central nervous system (CNS). Early treatment is the key for neurological recovery.

Methods: A case of ADEM associated with varicella-zoster virus infection was presented, in which magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) examinations were included.

Results: Magnetic resonance imaging of the brain revealed multiple hyperintense lesions at the subcortical level on fluid-attenuated inversion recovery (FLAIR), and MRI of the spinal cord revealed longitudinally segmented hyperintense lesions at the spinal cord on T2-weighted images. The patient was treated with methylprednisolone and gancyclovir, and had a favorable recovery. Subsequent MRI of the brain and cervical cord showed the previous abnormal hyperintensities had markedly disappeared.

Conclusion: A rare case of ADEM with longitudinal segmented hyperintense lesions at the spinal cord on T2-weighted images was presented. Excellent response to ADEM treatment with high-dose steroids was reported resulting in a remarkable neurological recovery. A long-term follow-up is needed for prognosis.

Keywords: acute disseminated encephalomyelitis; central nervous system; multiple sclerosis; neuroimaging.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
MRI‐scan 3 days after symptom onset. Brain MRI FLAIR image showing areas of hyperintensity involving subcortical white matter of both cerebral hemispheres, pedunculus cerebellaris medius bilaterally, and upper cervical cord. But not obvious on other MRI sequences. (a) Axial T1. (b) Axial T2. (c) Axial DWI (diffusion‐weighted imaging). (d) Sagittal T2‐FLAIR. (e) Coronal T2‐FLAIR. (f) Coronal T1 gadolinium‐enhanced
Figure 2
Figure 2
MRI‐scan 4 days after symptom onset. Cervical cord MRI image showing areas of T2 prolongation on the central spinal cord like H, and the cervical cord was swollen. (a) Sagittal T1. (b) Sagittal T2. (c) Axial T2
Figure 3
Figure 3
MRI‐scan 4 days after symptom onset. Thoracic cord MRI image showing areas of T2 prolongation in the central spinal cord. (a) Sagittal T2. (b) Sagittal T1 Gd‐enhanced. (c) Axial T2
Figure 4
Figure 4
MRI‐scan after treatment. Coronal brain MRI FLAIR image showing no significant change in the appearance of the previous lesions. Cervical cord MRI image showing no significant change in the appearance of the prior lesions, and the appearance of the spinal cord was normal. (a) Coronal brain T2‐FLAIR. (b) Sagittal cervical cord T1. (c) Sagittal cervical cord T2
See this image and copyright information in PMC

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