Recurrent Acute Disseminated Encephalomyelitis Presenting as Conus Medullaris Syndrome: A Case Report

Medicina, 2024 · DOI: https://doi.org/10.3390/medicina60010188 · Published: January 22, 2024

Neurology Spinal Disorders Research Methodology & Design

Simple Explanation

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that typically follows an infection or recent vaccination. It can cause swift and progressive neurological decline. This case report describes a middle-aged man who experienced recurrent ADEM affecting the spinal cord, specifically manifesting as conus medullaris syndrome, which impacts the lower spinal cord and nerve roots. High-dose steroid treatment led to significant neurological recovery after both the initial occurrence and subsequent attacks of spinal ADEM in this patient.

Study Duration

3-year follow-up period after the second attack

Participants

A 58-year-old male

Evidence Level

Case Report

Key Findings

1
The patient presented with rapidly progressive bilateral lower extremity tingling, numbness, and mild gait disturbance, indicative of conus medullaris syndrome.
2
Spinal MRI revealed a diffuse, longitudinal, high-signal lesion with mild enlargement of the conus and proximal cauda equina, predominantly localized in the distal conus and cauda equina.
3
Serial electrodiagnostic studies showed that the lesions progressed toward the proximal conus in tandem with symptom evolution and lacked clear lateralization.

Research Summary

This case report describes a middle-aged adult who experienced recurrent spinal ADEM, presenting as conus medullaris syndrome. High-dose steroid treatment resulted in significant neurological recovery. The patient's initial symptoms included rapidly progressive lower extremity issues, and MRI revealed lesions in the conus medullaris and cauda equina. Electrophysiological studies tracked the lesion progression. The diagnosis of spinal ADEM was made after excluding other neuroinflammatory conditions, and the patient showed complete improvement after steroid treatment for both the initial and recurrent episodes.

Practical Implications

Differential Diagnosis

Spinal ADEM should be considered in the differential diagnosis of transverse myelitis and other spinal cord disorders, even in the absence of brain involvement.

Treatment Efficacy

High-dose corticosteroids can be an effective treatment for spinal ADEM, leading to significant neurological recovery.

Long-Term Monitoring

Patients with spinal ADEM should be monitored for recurrence and potential development of other demyelinating diseases, such as multiple sclerosis.

Study Limitations

1
Single case report limits generalizability
2
Anti-MOG antibody testing was not performed
3
The precise nature of MRI signal changes (residual vs. new lesions) remains uncertain

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