Acute disseminated encephalomyelitisin the intensive care unit:clinical features and outcome of 20 adults.
OBJECTIVE
Because acute disseminated encephalomyelitis (ADEM) is a rare disease in adults admitted to the intensive care unit (ICU), we describe its characteristics and patient outcomes.


METHODS
A retrospective (2000-2006), observational, multicenter study was conducted in seven medical ICUs. Clinical, biological and neuroimaging features of patients diagnosed with ADEM were evaluated. Functional prognosis was graded using the modified Rankin (mR) scale.


METHODS
None.


RESULTS
At ICU admission, the 20 patients' median (25th-75th percentile) Glasgow coma score (GCS) was 7 (4-13), temperature 39 (38-39) degrees C. Six (30%) patients had seizures, 17 (85%) had a motor deficit and 14 (70%) required mechanical ventilation. Fifteen (75%) patients had cerebrospinal fluid pleocytocis. All patients had white-matter lesions on their magnetic resonance images. All patients received high-dose steroids. Five (25%) patients died. Fourteen (70%) patients were able to walk without assistance (mR<or=3) at follow-up [7 (3-9) months]. Compared to the latter, patients who died or were severely disabled at the follow-up evaluation [6 (30%) patients, mR>3] had significantly lower GCS (4 (3-4) vs. 12 (7-13), p=0.002) and more frequent seizures [4 (67%) vs. 2 (14%), p=0.02] at admission.


CONCLUSIONS
Unlike previous reports, our results showed that ADEM requiring ICU admission is a severe disease causing high mortality, and 35% of the patients had persistent functional sequelae. Intensivists should be aware of ADEM's clinical features to initiate appropriate immunomodulating therapy.
Sonneville
Romain
R
Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris 7, 46, rue Henri Huchard, 75877 ParisCedex 18, France. rsonneville@yahoo.com
Demeret
Sophie
S
Klein
Isabelle
I
Bouadma
Lila
L
Mourvillier
Bruno
B
Audibert
Juliette
J
Legriel
Stéphane
S
Bolgert
Francis
F
Regnier
Bernard
B
Wolff
Michel
M
D018806:APACHE; D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000328:Adult; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007275:Injections, Intravenous; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; C025429:methyl prednisolonate; D011239:Prednisolone