Adult-onset acute disseminated encephalomyelitis mimicking complex migraine: A CARE-compliant case report

Abstract

Rationale: Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder of the central nervous system, often triggered by infection or vaccination. It is rare in adults and can mimic other conditions, including complex migraine, leading to potential misdiagnosis and delayed treatment.

Patient concerns: A 35-year-old male presented with a progressive course of headache, visual disturbances, and altered mental status after an initial diagnosis of migraine.

Diagnoses: Initial imaging was nonspecific; however, repeat magnetic resonance imaging showed multifocal high T2-weighted fluid-attenuated inversion recovery signal intensities. Cerebrospinal fluid analysis revealed elevated protein and lymphocytic pleocytosis. Infectious and autoimmune causes were excluded, supporting a diagnosis of ADEM.

Interventions: The patient was treated with high-dose intravenous methylprednisolone followed by a tapering course of oral corticosteroids. Supportive therapy included antipsychotics and anticonvulsants.

Outcomes: Substantial clinical improvement was noted, including restoration of orientation and motor function. At the 2-week follow-up, the patient remained neurologically stable.

Lessons: This case emphasizes the importance of considering ADEM in adults with atypical migraine presentations. Early recognition and corticosteroid therapy can lead to favorable outcomes.

Keywords: ADEM; adult-onset ADEM; central nervous system disorder; demyelinating disorders; migraine; neurology case report.

Figure 1.

(A) T2-weighted MRI showing hyperintense lesions in the periventricular and subcortical white matter, consistent with areas of active inflammation and demyelination seen in ADEM. The red arrow indicates one of these lesions. (B) FLAIR MRI showing the same hyperintense lesions, one of which is indicated by the red arrow, with better delineation due to the suppression of the CSF background. ADEM = acute disseminated encephalomyelitis, CSF = cerebrospinal fluid, FLAIR = fluid attenuated inversion recovery.