A Rare Case of Acute Disseminated Encephalomyelitis: A Case Report

Case Diagnosis: Acute disseminated encephalomyelitis (ADEM) diagnosed in a middle-age, adult male.

Case Description or Program Description: A 46-year-old male with a history of depression, latent TB, and previous psych admission presented to the hospital for acute disseminated encephalomyelitis (ADEM) seen on MRI and treated with acyclovir. Prior to this incident, the patient was working and had no issues with ambulating or activities of daily living. The patient was initially admitted with altered mental status and rhabdomyolysis, deemed not to have capacity, and advised to continue on home olanzapine and fluoxetine. Upon rehab admission, the patient was ambulating 50 feet with a rolling walker, was found to be impulsive, and placed on 1:1 observation. During rehabilitation admission, the patient’s dosage of seroquel and gabapentin were adjusted and subsequently the patient’s impulsivity significantly improved and thus was able to better participate in therapy.

Setting: Nassau University Medical Center inpatient PM&R floor

Assessment/Results: Upon discharge, the patient was able to ambulate 150 feet with distant supervision without an assistive device. The patient's impulsivity was improved and was able to be discharged home.

Discussion (relevance): Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune, demyelinating disorder of the central nervous system that mostly affects children and young adults. Although typically seen in children, it also occurs in adults with disease features slightly different from pediatric cases. It has a parainfectious origin and is caused by cross-reactivity between myelin autoantigens and viral proteins. Patients usually present with a rapidly progressing, multifocal course with symptoms such as motor, sensory, cranial nerve, and/or brainstem impairment, altered mental status, and impaired vision. The diagnosis of ADEM should be suspected in a child who develops multifocal neurologic abnormalities with encephalopathy. Immunotherapy using high-dose glucocorticoids, IV immunoglobulin , or plasma exchange is recommended. Most children with ADEM make a full recovery, but a minority may have persistent motor or cognitive impairments.

Conclusions: This case report was written to highlight a rare incidence of ADEM outside the typical pediatric population, while emphasizing the significant role of effective psychiatric care in facilitating the patient's rehabilitation recovery.