Child with ADEM - Pediatric Oncall

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Childhood Ailments

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Question
2 yr male child referred to me as a case with h/o fever 5 days altered sensorium 4 days, unconsciousness 3 days? Seizure. On exam, I found RT facial palsy and rt ul monoparesis, neck rigidity was positive, b/l planter upgoing, b/l pupil dilated? Due to Mydriatricsatropine ointment applied, fundus was WNL responding poorly to deep painful stimuli. Other system ANL. I kept the possibility of ADEM. I kept on i/v cefipime, amikacin, mannitol. Investigations were Widal -ve, MP -ve, CSF 10 lymphos, Protein 96, CT 1 hypodense lesion on parieto-occiptal region. Next day develops lt ll paresis. MRI report on next day was s/o of ADEM. I started methyl pred pulse therapy, I also added acyclovir. Child showed improvement on 3rd day, now 7th day of admission, he is moving all limbs, facial improved, accepting orally well, my worry is, he is not speaking and visual perception is also poor, pupil still dilated, I'm tapering steroid, my plan to taper prednisolone in next 8 days, to complete acyclovir 10days, Cefi pime 14 days. my? How long I can wait for recovery, or any other help ?
Answer
A child with ADEM may need steroids for a long time till there are reversal of MRI findings. Stopping the steroids in a short time may lead to relapse and recurrence of symptoms. Also if you are suspecting viral encephalitis especially herpes, an EEG would be useful to looks for pleds. Pupils may remain dilated for 2-3 weeks after atropine. Since visual perception is poor, one should evaluate whether it is a cortical involvement or problem in the pathway by doing a VEP, if required. If cortical, due to plaques in the occipital lobe, steroids may be required for a very long time. It is ideal that a neurologist evaluates him for the ADEM. Back to All Questions

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