A Case of Acute Disseminated Encephalomyelitis with Marked Cerebrospinal Fluid Pleocytosis
Hyung-Jun Kim, MD, Saeromi Kim, MD, Jung-Gon Lee, MD, Kyung-Bok Lee, MD, Hakjae Roh, MD and Moo-Young Ahn, MD
Department of Neurology, College of Medicine, Soonchunhyang University, Seoul, Korea
ABSTRACT
Background: The diagnosis of acute disseminated encephalomyelitis (ADEM) is based on clinical feature supported by radiologic and laboratory tests. The cerebrospinal fluid (CSF) may show a mild lymphocytic pleocytosis and raised protein. Case Report: We describe an atypical case of ADEM that a previously healthy 38-year-old women, who showed deep drowsiness, confusion, paraparesis and dysuria from the 10th day after recent upper respiratory infection. Brain magnetic resonance image (MRI) revealed multifocal asymmetrical T2W/fluid attenuated inversion recovery hyperintensities in bilateral subcortical white matter. The white blood cell count in CSF was highly elevated to 313/mm3. However, her symptoms were not controlled by antibiotics but distinctively subsided with high dose steroid pulse therapy. No recurrent neurologic symptom and newly developed lesion in MRI was observed thereafter. Conclusions: This case suggests that a highly elevated CSF pleocytosis should not exclude the diagnosis of ADEM, which should be considered by clinical course as well as neurologic examination.
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