ADEM: Literature review and case report of acute psychosis presentation

Acute disseminated encephalomyelitis is a monophasic, immune-mediated disor der that produces multifocal demyelinating lesions within the central nervo us system. It is characterized clinically by the acute onset of neurologic abnormalities, including varying degrees of mental state changes ranging fr om drowsiness to coma, It is unusual for the illness to present as an isola ted acute psychosis, The case of a 14-year-old female with biopsy-confirmed acute disseminated encephalomyelitis, who was initially diagnosed with an acute psychiatric disorder, is presented, and published reports on this unu sual manifestation are reviewed. A Medline database search was performed fr om 1965 to 1999, using the terms acute disseminated encephalomyelitis, post vaccinal encephalomyelitis, postinfectious encephalomyelitis, and measles e ncephalomyelitis, combined with the terms psychosis, psychiatric disorder, and behavioral disorder, Selected cross-referenced reports were also review ed, Nine patients were identified who presented with acute psychosis, We co nclude that, although rare, acute disseminated encephalomyelitis can presen t as an acute psychosis, This immune-mediated condition should be included in the differential diagnosis of neurologic disorders presenting as a psych iatric illness, (C) 2000 by Elsevier Science Inc. All rights reserved.