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KMID : 0391520130210030176
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Journal of the Korean Child Neurology Society
2013 Volume.21 No. 3 p.176 ~ p.183
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Acute Disseminated Encephalomyelitis with Psychotic and Parkinsonian Features: A Case Report
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Sim Eun-Hee
Yum Mi-Sun
Kim Eun-Hee
Choi Hye-Won
Ko Tae-Sung
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Abstract
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Acute disseminated encephalomyelitis (ADEM) is a monophasic immune-mediated demyelination disorder that can arise following infection or immunization. Typical MRI findings show multifocal demyelinating lesions in the CNS. The presenting features include acute encephalopathy with multifocal neurologic signs, and patients often progress to develop delirium and/or coma, but acute psychosis is rare. In our current report, we describe a case of a 14-year-old boy presenting with parkinsonian features (masked face, bradykinesia, resting tremor, slow strides) as well as aggressive behavior and irritability with persecutory delusions that developed 3 days after an upper respiratory tract infection. T2-weighted/FLAIR brain MRI showed increased signal intensity in the hippocampus and basal ganglia including in the caudate nuclei. Cerebrospinal fluid (CSF) enterovirus PCR was positive. After treatment with high-dose methylprednisolone and antipsychotics, he recovered without permanent disabilities, and the initial lesions found on MRI disappeared on follow-up.
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KEYWORD
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Acute disseminated encephalomyelitis, Psychosis, Parkinsonian disorder, Enterovirus
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