Acute disseminated encephalomyelitis--a prospective study of clinical profile and in-hospital outcome predictors.
BACKGROUND
There is paucity of data on acute disseminated encephalomyelitis (ADEM) in adults in India. Recent reports indicate that demyelinating disorders in the eastern hemisphere are quite distinct from conventional western type multiple sclerosis.


OBJECTIVE
This study aimed to study the clinical profile, laboratory and imaging parameters, in-hospital morbidity/ mortality and clinical and imaging predictors of in-hospital outcome in ADEM.


RESULTS
A total of 29 patients were studied, gender ratio being not significantly different. Prior infection was present in 55.1% patients. Motor deficits (68.9%), bowel bladder abnormalities (65.5%) and sensory deficits (24.1%) were the commonest presenting features. Encephalopathy was seen in 24.1% patients. 10.3% patients had seizures and meningism. A polysymptomatic presentation was seen in 79.3% patients. Pure spinal cord affection (41.3%) was the commonest MRI pattern followed by subcortical (31%) and periventricular white matter involvement (24.1%). A normal MRI was seen in 17.2% of patients. 63% patients showed raised Cerebrospinal fluid (CSF) protein. The commonest in-hospital morbidity was urinary tract infection (18.5%). At admission; 81.4% patients had modified Rankin's score (MRS) between 4 and 6. At 6 weeks post admission, 90.4% patients had MRS score between 0-3, i.e, a favourable MRS.


CONCLUSIONS
This short term, in-hospital study of ADEM showed preponderance of polysymptomatic onset with motor deficits, commonest MRI pattern being pure spinal cord involvement. A good prognosis for short-term recovery at 6 weeks was noted, despite moderate to severe disability at admission.
Department of Medicine, LTMMC and LTMGH, Sion, Mumbai.
Uma
U
Sundar
Makardhwaj S
MS
Shrivastava
D000328:Adult; D000368:Aged; D002555:Cerebrospinal Fluid; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004673:Encephalomyelitis, Acute Disseminated / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007194:India / Q000453:epidemiology; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D013116:Spinal Cord / Q000473:pathology*; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors
D013256:Steroids