Abstract
We report a case of acute disseminated encephalomyelitis (ADEM) complicated by organophosphorus poisoning and lumbar spondylosis. A 62-year-old man with a history of bronchial asthma and prostatic hyperplasia was admitted to our hospital due to weakness of the lower extremities, intestinal obstruction, and disturbance of consciousness. He also experienced myosis and sialorrhea, following episodes of headache and fatigue. Lumbar X-ray CT findings and the history of exposure to organophosphorus compounds indicated lumbar spondylosis and poisoning, respectively. Because of unstable circulation and respiration, he was admitted to the ICU. Ten days later, the patient developed hypesthesia below the level of Th4, and 13 days later, meningeal irritation syndrome was observed. Additional diagnosis based on MRI findings, cerebrospinal fluid analysis, and monophasic process indicated ADEM. In the present case, expansion of the paralyzed area contributed to establishing the diagnosis, although the misleading case history made early diagnosis difficult.
