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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Inflammatory Demyelination | 6A0 Case 6 History
Case 6 History ---- This 8-year-old girl had a history of presumed acute disseminated encephalomyelitis that was first noted two years ago when she had headaches, fevers, and shingles after a tick bite. Since that time, she has had MRI scans demonstrating multiple intracranial lesions with some contrast enhancement and T2 hyperintensity within both cerebral hemispheres (right parieto-occipital white matter is the most affected) as well as within the right cerebral peduncle, midbrain, and superior pons. Considering the patient's history, these findings are highly suspicious of a demyelinating process such as ADEM. The MRI appearance of these lesions has changed over time, and she has developed a new right frontal lesion generating concern that there might be ongoing infectious or inflammatory process which prompted a brain biopsy. She received a diagnosis of active inflammatory demyelinating disease. Seven years later she is doing very well without clinical relapse and she is off Imuran for the last 3 years. Repeat MRI did not show any new lesions.
