Elias Matthew D, Narula Sona, Chu Andrew S
From the Divisions of *General Pediatrics and †Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Emerg Care. 2014 Apr;30(4):254-6. doi: 10.1097/PEC.0000000000000107.
Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initial presentation was manifested by prolonged fever, gray matter signal abnormality on brain magnetic resonance imaging, cerebrospinal fluid pleocytosis, and a markedly irritable mental status. As her neurological examination changed with focal abnormalities, a repeat magnetic resonance imaging demonstrated new areas of both gray and white matter signal abnormality, consistent with ADEM. Her symptoms and imaging findings completely resolved with a course of methylprednisolone. Based on the literature and this current case, it is our recommendation to consider ADEM as a diagnosis if meningoencephalitis is not improving.
脑膜脑炎和急性播散性脑脊髓炎（ADEM）均为神经疾病过程，但在儿科人群中，脑膜脑炎进展为ADEM的病例较少。本文报告了一例初诊为脑膜脑炎的4岁女孩，其最初表现为持续发热、脑磁共振成像显示灰质信号异常、脑脊液细胞增多以及明显烦躁的精神状态。随着她的神经检查出现局灶性异常变化，重复磁共振成像显示新的灰质和白质信号异常区域，符合ADEM。经过一个疗程的甲基泼尼松龙治疗，她的症状和影像学表现完全消失。基于文献和当前这个病例，我们建议如果脑膜脑炎没有改善，应考虑诊断为ADEM。
