Therapeutic hypothermia with the use of intracranial pressure monitoring for acute disseminated encephalomyelitis with brainstem lesion: a case report.
Acute disseminated encephalomyelitis confined to the brainstem is associated with poor prognosis. We describe a case of a 10-year-old boy with acute disseminated encephalomyelitis in the brainstem that developed after influenza A infection. A 10-year-old boy presented with fever and prolonged disturbance of consciousness and was admitted to our hospital. Magnetic resonance imaging (MRI) of the midbrain, with T2-weighted and fluid-attenuated inversion recovery images, suggested acute disseminated encephalomyelitis accompanied by a brainstem lesion. Lumbar puncture showed pleocytosis and increased protein content, including myelin basic protein, interleukin-6, and immunoglobulin G, all suggestive of acute disseminated encephalomyelitis. Treatments such as methylprednisolone pulse therapy, intravenous immunoglobulin, and therapeutic hypothermia were performed. Although the patient presented with anisocoria with increased intracranial pressure monitoring during hypothermia, prompt therapy with d-mannitol and dopamine was effective. Our case results suggest that hypothermia could be included in the choice of therapy for acute disseminated encephalomyelitis with brainstem lesions.
Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan kenmimi@dokkyomed.ac.jp.
Kenji
K
Miyamoto
Department of Intensive and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.
Seiki
S
Kozu
Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan.
Akiko
A
Arakawa
Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan.
Tatsuo
T
Tsuboi
Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan.
Jun-Ichi
J
Hirao
Department of Intensive and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.
Kazuyuki
K
Ono
Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan.
Osamu
O
Arisaka
D001933:Brain Stem / Q000473:pathology*; D002648:Child; D004673:Encephalomyelitis, Acute Disseminated / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D009980:Influenza A virus; D007251:Influenza, Human / Q000150:complications; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D064926:Neurophysiological Monitoring / Q000379:methods*
acute disseminated encephalomyelitis; hypothermia; intracranial pressure