Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis.
A 9-year-old boy presented with a subacute history of optic neuritis followed by brainstem involvement, with fever and a lymphocytic pleocytosis in the cerebrospinal fluid. Gadolinium-enhancing ring lesions were demonstrated in the white matter of the cerebrum, brain-stem and cerebellum on day 17 of the illness, all appearing simultaneously as part of a monophasic illness. A parietal lesion exerted mass effect. Needling and biopsy yielded no evidence of a pyogenic lesion, tumour or tuberculosis and showed vasculitis. There was insufficient material for myelin staining. Dexamethasone therapy lead to rapid improvement of the radiological lesions: MRI and CT on day 34 of the illness showed complete clearing of the lesions except for residual abnormality at the biopsy site.
van der Meyden
C H
CH
Department of Neurology, University of the Orange Free State, Bloemfontein, South Africa.
de Villiers
J F
JF
Middlecote
B D
BD
Terblanchè
J
J
D000208:Acute Disease; D001707:Biopsy, Needle; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D002648:Child; D003287:Contrast Media; D003907:Dexamethasone / Q000008:administration & dosage; D004679:Encephalomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008578:Meninges / Q000098:blood supply; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D003907:Dexamethasone; D019786:Gadolinium DTPA