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Acute disseminated encephalomyelitis after herpes virus encephalitis: case report


Journal of Neurology & Stroke
Celyna Scariot Grezzana, Fernanda Emilia Rocha, Larissa Alessandra Mehl, Marco Otílio Wilde, Rômulo Fonseca de Matos, Felipe Cesar Pereira Santos, Sandra Mara Witkowski

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Abstract

Acute disseminated encephalomyelitis (ADEM), is an acute demyelinating disease of an inflammatory character of the central nervous system, almost always related to previous viral infections or vaccination. This case is about a 10 years-old girl presented with nystagmus, somnolence, lip rhyme deviation and ataxic gait. During the hospitalization, she developed a complex partial seizure and continued with progressive worsening of symptoms, amnesia, mental confusion, irritability, dysarthria, ataxia, sphincter incontinence, decreased visual acuity, and insomnia. The brain nuclear magnetic resonance examination with altered signal in cortex, cerebellum and thalamus, changes in white matter compatible with demyelinating substrate, without acute inflammatory lesion and serology results reveals Herpes simplex virus 1 and 2 IgG and IgM positive. Based on neurological conditions and complementary exams, the diagnosis of acute disseminated encephalomyelitis after herpetic infection was defined. This case shows how difficult it is to make a diagnosis when there is a possible overlap of symptoms with herpetic encephalitis. And how is essential a long-term followup to differentiate from diseases such as multiple sclerosis, which unlike ADEM, there are several outbreaks throughout life

Keywords

acute disseminated encephalomyelitis, demyelinating disease, herpetic encephalitis

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