title: A 17 year-old girl with a demyelinating disease requiring mechanical ventilation: a case report.
abstract: BACKGROUND
  Demyelinating diseases cause destruction of the myelin sheath, while axons are relatively spared. Pathologically, demyelination can be the result of an inflammatory process, viral infection, acquired metabolic derangement and ischemic insult. Three diseases that can cause inflammatory demyelination of the CNS are: Multiple sclerosis (MS), Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis. Differentiation is not always easy and there is considerable overlaping. Data about adults with acute demyelination requiring ICU admission is limited.
  
  
  METHODS
  A 17 year old Greek female was hospitalised in the ICU because of acute respiratory failure requiring mechanical ventilation. She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. A demyelinating central nervous system (CNS) disease, possibly post infectious encephalomyelitis (ADEM) was the underlying condition. The MRI of the brain disclosed diffused expanded cerebral lesions involving the optic nerve, basal ganglia cerebellum, pons and medulla oblongata. There was also extended involvement of the cervical and thoracic part of the spinal cord. CSF leukocyte count was elevated with lymphocyte predominance. The patient required mechanical ventilation for two months. Then she was transferred to a rehabilitation centre. Three years later she remains paraplegic. Since then she has not suffered any other demyelination attack.
  
  
  CONCLUSIONS
  Demyelinating diseases can cause acute respiratory failure when the spinal cord is affected. Severe forms of these diseases, making necessary ICU admission, is less frequently reported. Intensivists should be aware of the features of these rare diseases.
authors: Korgialenio-Benakio Red Cross Hospital of Athens, ICU, Athanasaki 1 str, Ampelokipoi, 11526, Athens, Greece. kats_ch@otenet.gr
authors: Chrysostomos
authors: C
authors: Katsenos
authors: Despoina
authors: D
authors: Androulaki
authors: Stavroula
authors: S
authors: Lyra
authors: Theodoros
authors: T
authors: Tsoutsouras
authors: Costas
authors: C
authors: Mandragos
mesh_terms: D000293:Adolescent; D003711:Demyelinating Diseases / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*