Acute disseminated encephalomyelitis and Guillain-Barré syndrome represent distinct demyelinating diseases that share an autoimmune pathogenesis. A history of viral infection or vaccination are essential for the diagnosis11. Deshmukh IS, Bang AB, Jain MA, Vilhekar KY. Concurrent acute disseminated encephalomyelitis and Guillain-Barré syndrome in a child. J Pediatr Neurosci 2015;10(1):61-3. https://doi.org/10.4103/1817-1745.154357
https://doi.org/10.4103/1817-1745.154357...
,22. Okumura A, Ushida H, Maruyama K, Itomi K, Ishiguro Y, Takahashi M et al. Guillain-Barré syndrome associated with central nervous system lesions. Arch Dis Child. 2002;86(4):304-6. https://doi.org/10.1136/adc.86.4.304
https://doi.org/10.1136/adc.86.4.304...
,33. Mohamed RR, Jan MM. Co-morbid Guillain-Barré syndrome and acute disseminated encephalomyelitis. Neurosciences (Riyadh). 2013;18(2):166-8..
A 26-month-old boy presented with fever 10 days after vaccination (inactivated polio vaccine and tetravalent), progressive drowsiness, lower limb strength/sensory loss and urinary retention. The cerebrospinal fluid showed mild pleocytosis and an elevated total protein concentration; it was negative for infections. The initial MRI study was compatible with acute disseminated encephalomyelitis, with no spine abnormalities (Figure 1).
Brain MRI revealed white matter hyperintensities lesions in T2/fluid- attenuated inversion recovery (FLAIR) (A, B) in the cerebral hemispheres and cerebellum, without restriction to water molecules diffusivity or gadolinium enhancement, suggestive of acute disseminated encephalomyelitis . Sagittal T1 SPIR post-gadolinium (C), without cauda equina root enhancement.
Ten days later, after therapy with corticosteroids, he experienced acute paraplegia. Follow-up brain and spine MRI scans demonstrated partial regression of brain lesions and nerve root thickening with intense enhancement extending along the cauda equina, compatible with Guillain-Barré syndrome. (Figure 2).
References
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1Deshmukh IS, Bang AB, Jain MA, Vilhekar KY. Concurrent acute disseminated encephalomyelitis and Guillain-Barré syndrome in a child. J Pediatr Neurosci 2015;10(1):61-3. https://doi.org/10.4103/1817-1745.154357
» https://doi.org/10.4103/1817-1745.154357 -
2Okumura A, Ushida H, Maruyama K, Itomi K, Ishiguro Y, Takahashi M et al. Guillain-Barré syndrome associated with central nervous system lesions. Arch Dis Child. 2002;86(4):304-6. https://doi.org/10.1136/adc.86.4.304
» https://doi.org/10.1136/adc.86.4.304 -
3Mohamed RR, Jan MM. Co-morbid Guillain-Barré syndrome and acute disseminated encephalomyelitis. Neurosciences (Riyadh). 2013;18(2):166-8.
Publication Dates
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Publication in this collection
May 2017
History
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Received
31 Aug 2016 -
Reviewed
29 Dec 2016 -
Accepted
03 Feb 2017