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Rehabilitation Practice and Science

Translated Title

急性瀰散型腦脊髓炎後之復健：病例報告

Abstract

Acute disseminated encephalomyelitis is a monophasic disorder of unknown pathogenesis, characterized by demyelination of the central nervous system. The possible T-cell immune-mediated inflammatory process, affecting mainly children and young adults, typically follows a recent infection or immunization. Meningeal symptoms are common early in the course and often begin 1-3 weeks after infection. Abnormalities of motor, sensory, gait, visual, and cognitive function are variable and depend on the location (cerebral white matter, brainstem, cerebellum, or spinal cord) of the most severely damaged areas of the nervous system. Acute disseminated encephalomyelitis is unusual in middle-aged or elderly adults. The mortality rate is high in the patients with severe cerebral damage after measles, rubella, or rabies vaccination. Sequelae include seizures, mental syndrome, muscular weakness, and atrophy. Although near complete recovery (over 90%) in young survivors is the hallmark of acute disseminated encephalomyelitis, its long-term effect on elderly patients is still in dispute owing to little experience. We presented here the case of a 49-year-old woman with bilateral congenital hip dislocation and chronic headache, who suddenly developed hoarseness and left-sided weakness. The full-bloom encephalopathic disturbances resulted in unresponsiveness, respiratory failure, and decorticate rigidity in two days. Physical examination revealed cranial nerve palsies, and bilateral positive Babinski sign and Hoffman sign. Her corneal reflexes, cough reflex, and swallowing reflex were all diminished. Oligoclonal bands were not found in her lumbar cerebrospinal fluid, and head computerized tomography (CT) did not show any abnormality. Brain magnetic resonance image (MRI) scans showed asymmetric areas of demyelinated plaques over the bilateral cerebral hemispheres, thalamus, and brainstem without mass effect. These findings are typical of the encephalitic form of acute disseminated encephalomyelitis. However, no obvious prior infections or vaccination were found. Methylprednisolone treatment and active rehabilitation much improved our middle-aged adult patient's clinical picture and functional status. After 1-year follow up, few residual lesions appeared in the brain MRI. The patient could walk independently with a walker, and her respiration, swallowing, and bladder functions returned to normal. Delayed post-encephalitic sequelae did not occur and her basic activities of daily living were totally independent. However, headache, mild dysarthria, and increased muscle tone remained. She was only partly able to perform the instrumental activities of daily living such as shopping because of poor endurance and calculation skill. The clinical features and rehabilitation problems related to acute disseminated encephalomyelitis are presented in this paper.

Language

Traditional Chinese

First Page

247

Last Page

253

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