title: Fulminant form of acute disseminated encephalomyelitis in a child treated with mild hypothermia.
abstract: We describe the case of a 3-year-old boy diagnosed with the fulminant form of acute disseminated encephalomyelitis (ADEM). He developed general fatigue, fever, drowsiness and difficulty in walking. He had extensive multiple high-intensity lesions in the white matter of the cerebrum and cerebellum, which are typical findings of ADEM. He became comatose and developed decerebrate rigidity with severe brain edema despite high-dose methylprednisolone therapy, and then was subjected to mild hypothermia therapy, and given i.v. immunoglobulin. The patient recovered remarkably with the sequela of only mild action tremor. The patient was considered to have acute hemorrhagic leukoencephalitis (AHLE), an extremely severe form of ADEM, in terms of the rapidly deteriorating clinical course and neuroimaging features. It was speculated that AHLE and ADEM might be a continuous disease spectrum. It is considered that the severe brain edema associated with ADEM or AHLE is a suitable indication for mild hypothermia therapy.
authors: Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan.
authors: Kazushi
authors: K
authors: Ichikawa
authors: Hirotaka
authors: H
authors: Motoi
authors: Yoshitaka
authors: Y
authors: Oyama
authors: Yoshihiro
authors: Y
authors: Watanabe
authors: Saoko
authors: S
authors: Takeshita
mesh_terms: D002675:Child, Preschool; D004673:Encephalomyelitis, Acute Disseminated / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D012720:Severity of Illness Index
keywords: acute disseminated encephalomyelitis; acute hemorrhagic leukoencephalitis; high-dose methylprednisolone; hypothermia; i.v. immunoglobulin