Education And Debate

Grand Rounds—Hammersmith Hospitals: Distinguishing acute disseminated encephalomyelitis from multiple sclerosis

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7060.802 (Published 28 September 1996) Cite this as: BMJ 1996;313:802

Genetic predisposition may differ

An acute inflammatory disease of the central nervous system may be associated with an infectious illness, and when this is an isolated event it is termed acute disseminated encephalomyelitis.1 2 The inflammation and oedema may be succeeded by demyelination, and similar features may be precipitated by infection in patients with a predisposition to multiple sclerosis. We present the case of a patient with an acute demyelinating condition and discuss the distinction between acute disseminated encephalomyelitis and multiple sclerosis.

Case history

A 33 year old woman presented with rapidly progressive loss of vision in her left eye. Four weeks previously she had had a non-productive cough and had received a five day course of antibiotics. The next week she had gone on holiday to Crete, where she developed a vomiting illness that persisted. A few days later she had noticed loss of sensation in the perianal and perineal region, with hesitancy and loss of sensation on micturition, and constipation. This had been followed a couple of days later by a numbness and paraesthesia, which progressed down both legs, with a similar sensation in the left hand. Nine days before presentation she was aware of a scotoma in her vision from the left eye, which progressed over the next five days to loss of vision with no appreciation of light in that eye, accompanied by pain on eye movement. She then noticed a loss of sensation in the right hand and tingling sensation around the left ear and neck, with slight slurring of speech. She had no history of any neurological symptoms or other illness and no family history of neurological disease.

EXAMINATION

She was generally well and without fever, with no abnormalities on cardiovascular, respiratory, and abdominal examination. She had a wide based, slightly spastic gait. There was slight increase in tone in …

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