engleski

The spectrum of disseminated encephalomyelitis.

Disseminated encephalomyelitis (DEM) is the acute or chronic response of the immune system to an antigen. It is noteworthy that it can affect simultaneously the central and peripheral portions of the nervous system, the latter clearly differentiating it from multiple sclerosis (MS). 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 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. In rare instances, it may occur in a matter of hours or days, or as late as several months, after a dated antigenic challenge such as a vaccination. Unfortunately, the recurrent or multiphasic, or the unusual progressive, forms of DEM are rarely recognized in adults in whom they are frequently misdiagnosed as MS, despite the fact that they are just as common as they are in children. Except for fever, headache, nausea and vomiting, alterations in the state of consciousness and cognitive abnormalities, the central nervous system symptoms of DEM, are very similar to those of MS. It is important to note that the triggering infection may be very mild or it 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. This review will illustrate different clinical and MRI presentations of DEM in order to emphasize the features which help to differentiate it from MS.

Acute disseminated encephalomyelitis; Multiple sclerosis; Recurrent disseminated encephalomyelitis; Multiphasic disseminated encephalomyelitis

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