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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | ADEM | 1A0 Case 1 History
Case 1 History ---- The patient was a 10 year old girl in her normal state of health until mid-December when she developed a cough and mild fever for which she received antibiotics and resolved within a week. Then, on Christmas Eve, she complained of dizziness which lasted overnight. She was taken to an outside hospital and received a diagnosis of pneumonia which was treated with several antibiotics. At the same time she began to complain of bifrontal headaches, nausea and vomiting. She was admitted to our hospital on December 29 with acute onset of left hemiparesis, facial weakness and altered mental status. MRI showed multifocal lesions, most involving the right occipital lobe and right temporal lobe but also the splenium of the corpus callosum and the left parietal lobe. She had an episode of unresponsiveness that was accompanied by anisocoria and posturing and was taken emergently to the operating room for right occipital craniotomy and corticectomy as well as open biopsy and debulking of part of the occipital lobe. Postoperatively she did well until she had another episode of decreased responsiveness and anisocoria. The patient was started on mannitol and an Intracranial pressure (ICP) monitor was placed but it was difficult to control her ICPs. The decision was made to leave her intubated and heavily sedated in the barbiturate coma. After maximizing medical therapy, her ICPs continued to be poorly controlled. The decision was made to take her to the operating room for a hemicraniectomy and decompression. Ten years later the patient was stable with spastic left hemiparesis and was seizure free for several years before they recurred. MRI examination at that time demonstrated no new active radiologic changes but substantial tissue loss.
