engleski

The spectrum of disseminated encephalomyelitis

Disseminated encephalomyelitis (DEM) is the response of the immune system to an antigen which can be acute or chronic. It is noteworthy that it can affect simultaneously the central and peripheral portions of the nervous system. Pathologically there are differences and gradations in the type and severity of damage that are seen mostly, although not exclusively in the white matter. Although DEM is generally considered to be a demyelinating disease, edema and inflammation, and even hemorrhage, are not only major constituents of the pathological response but may in some instances be the its only manifestations. DEM can be seen following a wide variety of viral infections and vaccinations ; the acute phase generally occurs within one to three weeks after the precipitating event. Chronic DEM is much rarer but has been reliably reported as late as several months after vaccination. The recurrent form of the DEM is of particular clinical importance. Unfortunately it is rarely recognized in adults in whom it is frequently misdiagnosed as multiple sclerosis (MS), despite the fact that it is just as common as it is in children. Except for fever, alterations of the state of consciousness and cognitive abnormalities of DEM, its central nervous system symptoms are very similar to those of MS. It is important to note that the triggering infection maybe very mild or the infection may be subclinical and escape attention. Magnetic resonance imaging (MRI) has made it possible to correctly diagnose DEM in its acute, chronic, recurrent and multiphasic forms because, in most instances, the images are quite typical. Nevertheless, in clinical practice, the images of DEM and MS are often confused resulting in the former being misdiagnosed as the latter, resulting in the inappropriate initiation of long term immunomodulatory treatment.

Disseminated encephalomyelitis; Mutiple sclerosis; Magnetic resonance imaging

nije evidentirano