title: Severe depression as an initial symptom in an elderly patient with acute disseminated encephalomyelitis.
abstract: We report a 63-year-old man with acute disseminated encephalomyelitis (ADEM), initially showing depression for one and a half months but subsequently meningoencephalitis followed by acute-onset myelopathy. Neuroradiological examinations of the brain demonstrated no focal lesion causative for his depression, while cerebrospinal fluid revealed elevated levels of inflammatory cytokines in parallel with disease activity. Because depression is usually a rare initial symptom for patients with ADEM, an increased production of inflammatory cytokines in the central nervous system as well as age-related alterations of immune response might have played an important role in the development of depression in this elderly patient.
authors.affiliation: Department of Neurology, Saku Central Hospital, Usuda.
authors.forename: M
authors.initials: M
authors.lastname: Matsuda
authors.forename: J
authors.initials: J
authors.lastname: Miki
authors.forename: K
authors.initials: K
authors.lastname: Tabata
authors.forename: S
authors.initials: S
authors.lastname: Ikeda
mesh_terms: D002555:Cerebrospinal Fluid / Q000378:metabolism; D003863:Depression / Q000134:cerebrospinal fluid / Q000209:etiology*; D004673:Encephalomyelitis, Acute Disseminated / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index