Acute disseminated encephalomyelitis

A number of animal diseases caused by viruses involve primary demyelination and often are associated with inflammation. These diseases are studied as animal models, which may provide clues about how a viral infection could lead to immune-mediated demyelination in humans [1, 5, 6]. Canine distemper virus causes a demyelinating disease, and the lesions in dog brain show a strong inflammatory response with some similarities to acute disseminated encephalomyelitis in man [ 1 ]. Visna is a slowly progressive demyelinating disease of sheep caused by a retrovirus [ 1 ]. 

Other acquired disorders affecting myelin in humans may be secondary to viral infections, neoplasias or immunosuppressive therapy. Acute disseminated encephalomyelitis, also called postinfectious or postimmunization encephalitis, represents a group of disorders usually of mixed viral-immunological etiology. The condition is most commonly related to a spontaneous viral infection, of which major examples are measles, smallpox or chickenpox [1,2]. 

The most common cause of primary demyelination is MS, so demyelinating optic neuropathy is often associated with MS. Other conditions have been implicated in demyelinating optic neuropathy, including acute transverse myelitis, acute disseminated encephalomyelitis, herpes zoster, Gnillain-Barre syndrome, Devic s nemomyelitis optica, Epstein-Barr virus, Charcot-Marie-Tooth syndrome, and chronic multifocal demyelinating nemopathy. 

Keywords Multiple sclerosis experimental allergic encephalomyelitis central nervous system virus cerebrospinal fluid T-cell receptor acute disseminated encephalomyelitis lymphocyte immune system... 

ADEM acute disseminated encephalomyelitis is an immune mediated disease of brain. It is brief but significant and results in direct myelin damage. It usually occurs following a viral infection or vaccination (commonly for measles, mumps or rubella), but it may also appear spontaneously. 

ADEM acute disseminated encephalomyelitis AT adoptive transfer... 

Acute disseminated encephalomyelitis after Japanese encephalitis immunization has been reported from Japan. 

Another report included seven cases of acute disseminated encephalomyelitis after administration of Japanese encephalitis vaccine between 1968 and 1990 (10). Three other cases of neurological complications after the use of Japanese encephalitis vaccine have been reported in Denmark. In two cases the clinical picture was consistent with acute demyelinating encephalomyelitis (SEDA-21, 334). 

Two deaths from acute anaphylaxis and four cases of acute encephalopathy or acute disseminated encephalomyelitis (two fatal), temporally related to Japanese encephalitis immunization, have been reported from the Republic of Korea (3). The live-attenuated vaccine developed and used in China had 98% efficacy in a two-dose schedule. Concern that a live vaccine derived from an encephaUtogenic virus might lead to vaccine-associated encephalitis could not be addressed satisfactorily, even... 

Matsuishi T. Acute disseminated encephalomyelitis after Japanese B encephahtis vaccination. Pediatr Neurol 1992 8(2) 137-9. 

Ohtaki E, Matsuishi T, Hirano Y, Maekawa K. Acute disseminated encephalomyelitis after treatment with Japanese B encephahtis vaccine (Nakayama-Yoken and Beijing strains). J Neurol Neurosurg Psychiatry 1995 59(3) 316-17. 

Acute disseminated encephalomyelitis occurred in a 14-year-old boy 22 days after rubella immunization... 

Tsuru T, Mizuguchi M, Ohkubo Y, Itonaga N, Momoi MY. Acute disseminated encephalomyelitis after hve rubella vaccination. Brain Dev 2000 22(4) 259-61. 

Acute disseminated encephalomyelitis has been reported 4 weeks after immunization with a polysaccharide meningococcal A - - C vaccine in a 23-year-old woman she recovered with glucocorticoid treatment (13). 

Py MO, Andre C. Encefalomielite disseminada aguda e vacinacao antimeningococica A e C. Relate de caso. [Acute disseminated encephalomyelitis and meningococcal A and C vaccine case report.] Arq Neuropsiquiatr 1997 55(3B) 632-5. 

Acute disseminated encephalomyelitis associated with polio vaccine has been reported (32). 

Ozawa H, Noma S, Yoshida Y, Sekine H, Hashimoto T. Acute disseminated encephalomyelitis associated with poliomyelitis vaccine. Pediatr Neurol 2000 23(2) 177-9. 

Acute disseminated encephalomyelitis developed in a 15-year-old boy after HDC vaccine immunization (SEDA-21, 337). 

Acute multiple sclerosis or acute disseminated encephalomyelitis Myehn vacuohzation increased inflammatory infiltrate... 

Altered mental status is a pre-requisite for the diagnosis of acute disseminated encephalomyelitis (ADEM), often a consequence of non-CNS infection or immunization (Tenembaum et al., 2007) The disorder is the subject of a complete chapter in this book, so this discussion wiU be limited to the mechanisms of brain injury as it pertains to encephalopathies mediated by brain inflammation. There is excellent evidence to suggest that the brain injury is primarily immune mediated and therefore inflammatory in nature. Antigenic similarities between the viral antigens... 

Tekkok SB, Brown AM, Westenbroek R, PeUerin L, Ransom BR. Transfer of glycogen-derived lactate from astrocytes to axons via specific monocarboxylate transporters supports mouse optic nerve activity. Journal of neuroscience research 2(X)5 81(5) 644-652 Tenembaum S, Chitnis T, Ness J, Hahn JS, Hahn JS. Acute disseminated encephalomyelitis. Neurology 2007 68(16 Suppl 2) S23-S36... 

Wingerchuk, D.M. and Lucchmetti, C.F. (2007) Comparative immunopathogenesis of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis. Current Opinion in Neurology, 20, 343-350. 

A 75-year-old woman developed acute disseminated encephalomyelitis within 3 weeks of receiving the seasonal influenza vaccine and died, despite treatment with methylpred-nisolone and plasma exchange. 

Shoamanesh A, Traboulsee A. Acute disseminated encephalomyelitis following influenza vaccination. Vaccine 2011 29 8182-5. 

Nervous system Several vaccines have been reported as potential triggers of acute disseminated encephalomyelitis, including HPV [25 ]. 

A 15-year-old girl developed acute disseminated encephalomyelitis 23 days after receiving a second dose of HPV vaccine. She had no history of other recent diseases, immunization, or infections. She was given high-dose glucocorticoids, which produced rapid neurological improvement and complete recovery after 3 weeks. 

An 83-year-old Hispanic woman had altered consciousness, fever and weakness 8 days following influenza vaccination. After alternative diagnoses, including infectious and non-infectious aetiologies, were excluded, a diagnosis of post-vaccination acute disseminated encephalomyelitis (ADEM) was made, and the author felt that there was a reasonable temporal relationship between vaccination and presentation with symptoms to support causality [31 ]. 

Maducado JD, Bhagya-Rao B, Davogustto G, McKelvy BJ. Acute disseminated encephalomyelitis following seasonal influenza vaccination in an elderly patient. Clin Vaccine hmnunol 2013 20(9) 1485-6. 

Fujii K, Suyama M, Chiba K, Okunushi T, CHkawa J, Kohno Y. Acute disseminated encephalomyelitis following 2009 HlNl influenza vaccine. Pediatr hit 2012 54(4) 539- 1. 

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