A I Ahmed1, C A Eynon, L Kinton, J A R Nicoll, A Belli. 1. Division of Clinical Neurosciences, University of Southampton, LD83, Level D, South Academic Block, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. a.ahmed@soton.ac.uk
Abstract
BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is a rare, acute demyelinating condition. Although it usually presents in an acute or subacute manner over days, its clinical course may be rapid with symptoms and signs of severe intracerebral mass effect secondary to cerebral oedema. METHODS: Case report and literature review. RESULTS: We report a case of a patient presenting with a hyperacute course manifested by rapid loss of consciousness and focal neurological signs. Management with emergency hemicraniectomy and steroids resulted in rapid neurological improvement and minimal long-term deficit. CONCLUSIONS: We believe that only surgical decompression is likely to be life saving in similar cases of hyperacute cerebral oedema due to ADEM. The wide decompression performed was concordant with that indicated for traumatic brain swelling. Such aggressive management is vindicated by the rapid recovery shown by our patient within days of surgery and the finding of minimal neurological sequelae at 3 months.
BACKGROUND:Acute disseminated encephalomyelitis (ADEM) is a rare, acute demyelinating condition. Although it usually presents in an acute or subacute manner over days, its clinical course may be rapid with symptoms and signs of severe intracerebral mass effect secondary to cerebral oedema. METHODS: Case report and literature review. RESULTS: We report a case of a patient presenting with a hyperacute course manifested by rapid loss of consciousness and focal neurological signs. Management with emergency hemicraniectomy and steroids resulted in rapid neurological improvement and minimal long-term deficit. CONCLUSIONS: We believe that only surgical decompression is likely to be life saving in similar cases of hyperacute cerebral oedema due to ADEM. The wide decompression performed was concordant with that indicated for traumatic brain swelling. Such aggressive management is vindicated by the rapid recovery shown by our patient within days of surgery and the finding of minimal neurological sequelae at 3 months.
Authors: S von Stuckrad-Barre; E Klippel; C Foerch; J-M Lang; R du Mesnil de Rochemont; M Sitzer Journal: Neurology Date: 2003-08-12 Impact factor: 9.910
Authors: P J Hutchinson; E Corteen; M Czosnyka; A D Mendelow; D K Menon; P Mitchell; G Murray; J D Pickard; E Rickels; J Sahuquillo; F Servadei; G M Teasdale; I Timofeev; A Unterberg; P J Kirkpatrick Journal: Acta Neurochir Suppl Date: 2006