IMMUNOGLOBULINS IN ACUTE, PARAINFECTIOUS, DISSEMINATED ENCEPHALO-MYELITIS

Acute, parainfectious, disseminated encephalo-myelitis (ADEM) is usual ly treated with corticosteroids. Intravenous immunoglobulins have not been applied to patients with ADEM. This article describes a 22-year o ld woman who developed progressive paraparesis, ascending sensory dysf unction, and urinary incontinence one week after tonsillitis. Guillain -Barre syndrome was diagnosed initially, and intravenous immunoglobuli ns (0.4 g/kg daily) were begun. Symptoms deteriorated after the first and second applications, but after the third application the patient's sensory level declined. After the fourth application, the deteriorati on of symptoms stopped and cerebrospinal fluid (CSF) abnormalities imp roved. Because of diffuse spinal cord swelling, intramedullary edema, and hyperintense white and grey matter lesions in the basal ganglia an d the corpus callosum on MRI scans, the diagnosis was corrected to ADE M. It is concluded that initial administration of intravenous immunogl obulins might be of therapeutic value in patients with ADEM.