Acute Central Nervous System Demyelination


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Acute Central Nervous System Demyelination

  1. 1. ACUTE DISSEMINATED ENCEPHALOMYELITIS Acute or Subacute Multifocal Neurologic Deficits with Encephalopathy Post Viral or Vaccination Fever, headache, neck pain, ataxia High Dose Steroids IVIg
  2. 2. MULTIPLE SCLEROSIS Chronic Recurrent episodes demyelination over space and time Oligoclonal bands may be present in CSF Interferon B Immunomodulatory, cytotoxic therapies
  3. 3. OPTIC NEURITIS First episode of inflammatory demyelinating event Isolated or in context of ADEM, MS, NMO Optic disk swollen in 75% MRI brain and orbits with gadolinium High dose steroids
  4. 4. TRANSVERSE MYELITIS Spinal cord Rapid onset over hrs or days Weakness, paresthesias, sphincter dysfunction, urinary retention Isolated or in context of ADEM, MS, NMO Overlap with Guillain Barre, MRI distinguishes Encephalopathy uncommon but may occur w/brainstem involvement High Dose Steroids IVIg Plasmapheresis
  5. 5. OTHER CONSIDERATIONS SLE Sarcoid Malignancy Mitochondrial Disease Leukodystrophy