Adult-Onset Acute Disseminated Encephalomyelitis Refractory to Steroids

Abstract

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated phenomenon characterized by demyelination of the central nervous system that displays numerous manifestations. It predominantly presents in children with a mean age range of five to eight years. ADEM remains a diagnosis of exclusion based on clinical and radiographic progression. Thus, it poses a diagnostic challenge. ADEM has been shown to be very responsive to steroids and exchange therapy. Here, we present an unusual case of ADEM in a 50-year-old female patient who, despite receiving an entire course of IV methylprednisolone and other conventional treatment methods, did not respond to the treatment.

Keywords: acute disseminated encephalomyelitis (adem); adult-onset; central nervous system; demyelination; neuroimaging.

Figure 1. Initial magnetic resonance image (MRI) showing multifocal patchy T2/FLAIR signal abnormalities

Yellow arrows in the image indicate multiple hypodense regions. FLAIR, Fluid-attenuated inversion recovery.

Figure 2. Non-contrast CT of the brain showing axial cuts at the basal ganglia

Yellow arrows display the hypodensities in the right parietal lobe, supratentorial, and infratentorial regions.

Figure 3. Final non-contrast CT of the brain

Yellow arrows show the labeled new hypodensity regions in the frontal lobe and white matter hypodensities in the right high parietal lobe.