[Episodic disseminated inflammation of the central nervous system. Case mix review over a 13 year period].
BACKGROUND
Episodic disseminated inflammation of the central nervous system (CNS) presents in processes that are difficult to differentiate, such as acute disseminated encephalomyelitis (ADE) and its multiphasic variants, and multiple sclerosis (MS). Magnetic resonance imaging allows these problems to be identified more frequently than in the past.


METHODS
We carried out a retrospective study of the cases of episodic disseminated inflammation of the CNS, according to clinical features and compatible neuroimaging, at the Neuropaediatric Unit of the Hospital Infantil Miguel Servet, between May 1990 and August 2003.


RESULTS
Of the 6777 children evaluated over this period, 10 met the eligibility criteria, with a minimum age at onset of 2 years and 2 months. In four cases there was a history of an infectious process or vaccination. Clinical involvement was multisymptomatic, the most frequent being ataxia, dysmetry, tremor, drowsiness, paresis and cranial nerve involvement. Six of them had cerebrospinal fluid disorders and only two presented disorders in the fundus oculi. Five of them were given corticoid treatment. Progress was favourable, except in two cases: one due to the persistence of a corticoid dependent optical neuropathy and the other because of dyskinesia in the right hand.


CONCLUSIONS
Diagnosis of ADE is established by signs of multifocal clinical involvement and neuroimaging, and depends on a compatible progression. Prognosis is generally good and corticoids seem to be effective, at least in shortening the time the clinical features last. It is not possible to completely differentiate it from MS, especially in recurring forms. Clinical and magnetic resonance controls must be carried out.
López Pisón
J
J
Hospital Universitario Miguel Servet, Zaragoza, España. jlopezpi@salud.aragob.es
García Bodega
O
O
Díaz Suárez
M
M
Bajo Delgado
A F
AF
Cabrerizo de Diago
R
R
Peña Segura
J L
JL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003953:Diagnosis-Related Groups; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000009:adverse effects; D018450:Disease Progression; D004673:Encephalomyelitis, Acute Disseminated / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis; D011055:Poliovirus Vaccine, Oral / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013745:Tetanus Toxoid / Q000009:adverse effects; D014611:Vaccination / Q000009:adverse effects
D015721:Diphtheria-Tetanus-Pertussis Vaccine; D011055:Poliovirus Vaccine, Oral; D013745:Tetanus Toxoid