Ophthalmologic manifestations in pediatric patients with acute disseminated encephalomyelitis.
BACKGROUND
Acute disseminated encephalomyelitis (ADEM) is an inflammatory syndrome affecting the central nervous system that often is associated with para-infectious causes. Optic neuritis is a common feature of this demyelinating disease, and a paucity of data regarding this entity exists in the ophthalmologic literature.


METHODS
We describe 10 pediatric patients with ADEM who presented at our institution between 1995 and 2003.


RESULTS
Six of these patients had optic neuritis, with visual acuities in the affected eyes ranging from 20/30 to light perception. Five of those with optic neuritis had bilateral disease. All patients were treated with high-dose methylprednisolone, and 4 of these patients had recovered with a visual acuity of 20/40 or better in the affected eyes. Two patients were lost to follow-up, and final visual acuities were not available. Nine of 10 patients had an identifiable preceding viral illness or immunization.


CONCLUSIONS
ADEM is a known cause of optic neuritis in children and should be considered by the ophthalmologist treating this population of patients. All patients in this series were treated with high-dose intravenous steroids followed by an oral steroid taper and/or intravenous immunoglobulin. Final visual outcomes were favorable in all patients.
Kotlus
Brett S
BS
Department of Ophthalmology, Long Island Jewish Medical Center, North Shore-Long Island Health Systems, Great Neck, NY 11021, USA.
Slavin
Michael L
ML
Guthrie
Deborah S
DS
Kodsi
Sylvia R
SR
D000284:Administration, Oral; D002648:Child; D002675:Child, Preschool; D004673:Encephalomyelitis, Acute Disseminated / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009900:Optic Nerve / Q000473:pathology; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014794:Visual Fields
D005938:Glucocorticoids; D011241:Prednisone; D008775:Methylprednisolone