Clinical and imaging features of 15 elderly patients with acute disseminated encephalomyelitis
TAN Xiaomu1, LIU Jianguo2, AN Li3, XIE Rui3, ZHANG Fengqun3, HUANG Xin1
1. Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China; 2. Department of Neurology, the First Medical Center of PLA General Hospital, Beijing 100853, China; 3. Department of Neurology, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China
Abstract：Objective To investigate the clinical and imaging characteristics of acute disseminated encephalomyelitis (ADEM) among elderly patients.Methods The clinical, laboratory and image data of fifteen elderly ADEM patients hospitalized between March 2013 and January 2019 was retrospectively analyzed.Results A total of 15 patients aged 60 to 77 were enrolled. Five of them had an acute onset and 10 a subacute onset. Among them, 2 cases had prodromal inducement. The first symptoms included headache (4 cases), hemiplegia (4 cases), paraplegia (2 cases), right facial twitch (1 case), diplopia (1 case), somnolence (1 case), abdominal pain (1 case) and visual disturbance (1 case). Head MR imaging showed lesions in 13 cases, and there was no significant difference in imaging manifestations between these elderly ADEM patients and children, middle-aged and young ADEM patients reported in the literature, but 2 cases in our study had tumefactive demyelinating lesions. Abnormal nerve conductive velocity was found in 4/6 cases, suggesting that the incidence of peripheral nerve damage in our study was higher than what was reported about younger ADEM patients in previous literature. At the end of follow-up, 8 patients were still suffering from moderate or severe neurological dysfunction or died, indicating that the prognosis was worse than what was reported about younger ADEM patients in previous literature.Conclusions Elderly patients with ADEM are characterized by fewer prodromal symptoms, milder onset, more atypical first symptoms, and more peripheral nerve involvement. They are prone to misdiagnosis and have relatively poor clinical prognosis.
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