rss
J Neurol Neurosurg Psychiatry 76:996-998 doi:10.1136/jnnp.2004.045500
  • Short report

Initial DWI and ADC imaging may predict outcome in acute disseminated encephalomyelitis: report of two cases of brain stem encephalitis

  1. H Axer1,
  2. A Ragoschke-Schumm1,
  3. J Böttcher2,
  4. C Fitzek2,
  5. O W Witte1,
  6. S Isenmann1
  1. 1Department of Neurology, Friedrich Schiller University Jena, Jena, Germany
  2. 2Department of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena
  1. Correspondence to:
 PD Dr med Hubertus Axer
 Department of Neurology, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany; Hubertus.Axermed.uni-jena.de
  • Received 11 May 2004
  • Accepted 29 October 2004
  • Revised 28 October 2004

Abstract

Two young patients with acute disseminated encephalomyelitis (ADEM) of the brain stem are described. In spite of similar lesion sites in the brain stem, reaching from the upper medulla to the mesencephalon, the outcomes of the patients were very different: one made a full clinical recovery within three weeks while the other remained in a locked-in state more than a year after the disease episode. Both patients also differed in magnetic resonance imaging (MRI) findings on admission. The patient who remained in a locked-in state had pathological diffusion weighted imaging (DWI) scans and decreased apparent diffusion coefficient maps initially, with severe tissue destruction on follow up computed tomography, while the patient who recovered fully showed initially increased apparent diffusion coefficient values and almost complete resolution of MRI changes on follow up. Thus a comparison of these two cases may indicate differences in the underlying pathology in ADEM (vasogenic v cytotoxic oedema) that may be crucial for estimating tissue damage and clinical outcome.

Footnotes

  • Competing interests: none declared

Podcasts
Visit the full archive of podcasts for JNNP here >>

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of JNNP.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article