ACUTE DISSEMINATED ENCEPHALOMYLITIS (ADEM) IN OMAN

Objectives: To examine the clinical characteristics, Radiological features and outcomes of patients with ADEM seen in Sultan Qaboos University Hospital, Oman.

Methods: A chart review analysis of patients with the diagnosis of ADEM. The criteria used for the inclusion as a case of ADEM, were the acute onset, preceding infections, hyperattenuation of the lesions in T2 weight MRI and rapid response to corticosteroids. 23 patients were included in the study seen in the period of 1993–2005.

Results: Twenty-three patients fulfilled the criteria. Seventeen (74%) males and 6 (26%) females. The mean age at presentation is 5.6 years (9 months- 11 years). 52% of the patients had a history of URTI prior to presentation. Only five patients had documented infection, three with chicken box and two with dengue fever. The most common presentation is a motor deficient. Other clinical presentation included Aphasia (35%), cerebellar signs (22%), meningeal irritation (17%), seizures (13%) and cranial neuropathies (17%). MRI was preformed at presentation in 18 (78%) of the patients. The most common finding (44%) was hyperattenuated lesions in subcortical white matter followed by basal ganglia (16%), Thalamus (16%), Cord edema 16% and cerebellum (11%). CSF was preformed in 12 (52%) patients. Only 5 of which had raised proteins. EEG was preformed in 8 patients. Seven patients showed generalized slowing. 13(56%) patients were treated with steroids alone. Nine (39%) received steroids followed by IVIG. One patient has not received any treatment due to rapid recovery within one day. Full recovery has occurred in 17 (74%) of the patients. Six (26%) patients had persistent neurological deficient.

Conclusion: This study is the first to describe a series of patients with ADEM in the Arabian Peninsula. In this series ADEM affects predominately boys. It has good prognosis and response to steroids. EEG when performed shows diffuse slowing indicating a subcortical white matter involvement.