ADEM IN CHILD OF MATO GROSSO DO SUL - A CASE REPORT

Resumo

Introduction: The Acute Disseminated Encephalomyelitis (ADEM) is a inflammatory demyelinating disease of the Central Nervous System¹^,2, with prevalent incidence in children at aged less than 10 years-old, and its probable etiology is autoimmune. It can be triggered by viral, bacterial infection or vaccination reaction. In children, the differential diagnosis can be given by multiple sclerosis, optic neuritis, transverse myelitis, neuromyelitis optica and infections, metabolic and rheumatologic conditions³. Case presentation: I.V.A., masculine, 9-years-old, resident of Dourados-MS, admitted on 28/08/2014 ate the Hospital da Vida complaining of hemiplegia on left side and was reffered to the Hospital Universitário. The patient showed neurological exam with plantar reflex to the left, muscle strength grade 1, gait with hemiplegia to the left and not showing change in level of conscience. A cranial CT scan was made and showed no alteration, and a head MRI scan showing alteration of intensity compromising the uncus/amygdale in both side and simetric, hipersignal in T2/FLAIR. There was cerebellar lesion to the left, and periventricular and internal capsule lesions similar to the demyelinating lesions. After the MRI results, the neurologist requested beginning of treatment with intravenous methylprednisolone 30mg/kg/d for 5 days, having a gradual recovery. Discussion: The case highlights a 9-years-old child that showed a sudden start of weakness, followed by hemiplegia to the left, preceded by a sinusitis. ADEM is a rare disease with benign prognosis if treated on time, and the MRI is a valuable tool to help in its diagnosis⁴. The case is notable for is a rare disease that should always be remembered when a previous infection is associated with a sudden start of paresis.