Acute Disseminated Encephalomyelitis Presenting as Papilledema Followed by Optic Neuritis

Abstract

We report a case diagnosed with acute disseminated encephalomyelitis(ADEM)presenting as papilledema followed by optic neuritis. A 7-year-old girl who had not recovered from mycoplasma sinusitis and complained of diplopia was referred to our hospital. Visual acuity was good, but bilateral optic disc edema was observed. No abnormal findings were found on MRI. Cerebrospinal fluid examination showed increased pressure and pleocytosis. She was hospitalized with a diagnosis of papilledema due to intracranial hypertension. The symptoms were improved with diuretics, but an acute bilateral loss of vision developed with relative afferent pupillary defect,bilateral optic disc erythema, and edema. Subsequent MRI findings and clinical course met the criteria for ADEM. A diagnosis of bilateral optic neuritis due to ADEM was made. Following steroid pulse therapy, her vision returned to normal. This case indicates that the initial episode of optic disc edema was papilledema caused by meningitis and that the second episode was optic neuritis caused by ADEM. ADEM is an acute demyelinating disorder of the central nervous system, which follows certain viral infections or vaccinations. It is very rare that the two different clinical episodes in this case occur successively. Distinctive brain MRI findings helped with the diagnosis of ADEM and with its follow-up. The case presented here is a good example of the consideration that should be paid to the relation between clinical course and MRI findings.