Akademik Veri Yönetim Sistemi
11th Eurasian Congress on Emergency Medicine, Antalya, Türkiye, 20 - 23 Kasım 2025, ss.326-327, (Özet Bildiri)
OBJECTIVE: Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating
disorder of the central nervous system, most frequently seen in children. Although typically associated
with encephalopathy and multifocal neurological deficits, its initial presentation may closely resemble
acute ischemic stroke, leading to diagnostic challenges in the emergency department. Early recognition
is crucial to avoid misdiagnosis, initiate appropriate immunotherapy, and prevent long-term neurological
sequelae. This case report highlights an adolescent presenting with stroke-like symptoms in the emergency
setting, later confirmed as ADEM.
CASE-DISCUSSION:A 16-year-old previously healthy male was admitted to the emergency department
with acute right-sided weakness and paresthesia progressing over three days. His history included an
upper respiratory tract infection two weeks earlier and influenza vaccination four days before onset. On
examination, he was alert and oriented, but demonstrated decreased muscle strength (right leg 2/5, right
arm 3/5), increased deep tendon reflexes, clonus, and bilateral Babinski signs. No fever was detected. The
clinical findings had a suspicion of ischemic stroke, prompting urgent neuroimaging.
Brain Magnetic Resonance Imaging (MRI) revealed multifocal periventricular white matter lesions and a
nodular brainstem lesion, both hyperintense on T2 and FLAIR, without contrast enhancement (Figure 1).
Spinal MRI was normal. Cerebrospinal fluid analysis showed no significant abnormalities, and viral PCR
identified rhinovirus. These findings, combined with the absence of vascular pathology on MR angiography
and venography, excluded ischemic stroke and supported the diagnosis of ADEM.
High-dose intravenous methylprednisolone (30 mg/kg/day, max 1 g/day) was promptly initiated. Significant
neurological improvement occurred within five days, and oral tapering was continued for two weeks.
Follow-up MRI showed regression of lesions, and at three months, the patient had complete neurological
recovery.
Acute disseminated encephalomyelitis can mimic stroke, especially when presenting with acute focal
deficits without encephalopathy. Emergency physicians must consider demyelinating disorders in the
differential diagnosis of pediatric stroke-like presentations. While stroke is rare in this age group, missing
an immune-mediated diagnosis can delay treatment. MRI remains the cornerstone in distinguishing ADEM
from vascular causes. Corticosteroids are first-line therapy, and most pediatric patients respond favorably,
as in this case.
CONCLUSION: Acute disseminated encephalomyelitis should be recognized as an important stroke mimic
in the emergency department, particularly in children and adolescents presenting with acute hemiparesis
following infection or vaccination. Rapid imaging and integration of clinical, laboratory, and radiological
findings are essential to differentiate ADEM from ischemic stroke. Early initiation of corticosteroid
therapy ensures favorable outcomes, as demonstrated by our patient who achieved full recovery within
three months. This case underlines the critical role of emergency clinicians in considering demyelinating
disorders in the differential diagnosis of pediatric stroke-like syndromes.