The document discusses acute disseminated encephalomyelitis (ADEM), a rare inflammatory disease of the central nervous system. ADEM is typically triggered by an environmental stimulus in genetically susceptible individuals. It most commonly affects children between 5-8 years old, with symptoms developing within 2 weeks of a viral or bacterial infection in approximately 50-75% of cases. Diagnosis is based on clinical presentation and MRI findings showing multifocal brain inflammation. Treatment involves high-dose corticosteroids, with plasma exchange or IVIG recommended for non-responders. Most children recover fully, but some have residual symptoms like headaches or behavioral issues.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
Ataxia is a medical condition which results in the lack of muscle coordination that usually affects voluntary movements such as walking, eye movements, speech, and the patient’s ability to swallow.
Ataxia is a medical condition which results in the lack of muscle coordination that usually affects voluntary movements such as walking, eye movements, speech, and the patient’s ability to swallow.
Clinical Guideline on COVID-19 Vaccination for Adolescents (12 – 17 years)
Prepared by Dr Nik Khairulddin Nik Yusoff, Paediatrician at Hospital Raja Perempuan Zainab II
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Introduction of Autoimmune encephalitis for Non medical professionals and mental health professionals work in neurology. Reference provided in last slide and prepared of self learning purpose not for any commercial purpose.
Measles and its prevention - Slideset by professor EdwardsWAidid
In this study Professor Kathryn M. Edwards (Sarah H. Sell and Cornelius Vanderbilt Professor - Division of Pediatric Infectious Diseases - Vanderbilt University Medical Center) provides an update on measles and its prevention.
To learn more, please visit www.waidid.org!
Brain tumor is an abnormal growth of the tissue in the brain.
The brain tumors can be mainly divided into two primary brain tumors and secondary/metastatic brain tumor
definition of malnutrition, the definition of protein-energy malnutrition , the etiology 0f protein-energy malnutrition, the pathophysiology of malnutrition, features of marasmus, features of kwashiorkor, vitamins and micronutrient deficiencies, signs of micronutrients deficiency, diagnosis, management of malnutrition,prognosis of malnutrition ,prevention of malnutrition
Definition of erythema infectiosum, the causative factor, clinical presentation, the three stages of rash, the slipped cheek, the sequences of the rash, the diagnosis of the fifth disease, the differential diagnosis of fifth disease, the treatment of erythema infectiosum, the prognosis of fifth disease , congenital erythema infectiosum, the complications of fifth disease , Human parvovirus B19
What is kingella kingae bacterium,features of K. kingae,Species of Kingella,epidemiology of k. kingae,Proposed pathogenesis of K. kingae infections,Transmission of k. kingae ,Pathegenesis of k. kingae,diagnosis ,NAAT for k.kingae ,treatment of k.kingae,prevension ,osteomyelitis due to k,kingae.endocarditis due to k.kingae,Septic Arthritis due to k. kingae,Spondylodiscitis due to k. kingae, prevention of k. kingae infection
What is congenital nephrotic syndrome ,what is the definition of congenital nephrotic syndrome,what is the inheritance,what are the responsible genes ,what are the types of congenital nephrotic syndrome,what is the presentation ,diagnosis ,and treatment of congenital nephrotic syndrome, primary type and secondary type of congenital nephrotic syndrome
What is nonalcoholic fatty liver disease, what is the prevalence among children ,the definition of NAFLD,What are the relationship between obesity and over weight with the development of NAFLD,what are the sequences ,what is NASH,Who are at risk , How to diagnosis NAFLD what is the differential diagnosis ,what is the treatment
#what is listeriosis #,listeria monocytoges ,#what is the mode of transmission,#food-born infection ,#vertical infection ,#early and late onset ,#meningitis و#Sepsis ;#Early vs.Late onset neonatal listeriosis ,diagnosis of neonatal listeriosis ,treatment of neonatal listeriosis ,prevention of neonatal listeriosis
What is achondroplasia, definition , etiology ,types of dwarfism , genetic background,clinical presentations ,history and clinical examination , differential diagnosis ,diagnostic tests ,radiological findings ,CT scan and MRI , Medical care and role of growth hormone ,Surgical care and consultation,
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
What is your knowledge regarding electrical burn in children,types of electrical burns in children.,characteristic features of each type ,minor electrical burn , high -voltage electrical burn ,lightning electrical burn what are the clinical presentations and management ,cardiac complication of electrical burn,neurological complication of electrical burn , cutaneous and oral complication ,masculoskeletal complication and ocular and renal complications
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
definition what is FPIES, what it defers from other food allergy, what are the signs and symptoms ,what are the different types of food allergy ,how to diagnose FPIES ,what are the oral food challenge (OFC) ,what is the treatment , the prognosis of FPIES
What is influenza ,ethology ,types ,presentations signs and symptoms ,epidemic influenza ,laboratory investigations , management , the WHO guidelines in dealing with cases and contact
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
حساسية الجلد ماهي فوائد الجلد ماهي الحساسية ماهي انواع حساسية الجلد ماهي العوامل التي تؤدي لحدوث الحساسية ماهي انواع الحساسية ماهي اعراض الحساسية ماهي طرق الوقاية من الحساسية ماهو علاج الحساسية
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Adem
1. Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@aol.com
* ADEM
(Acute Disseminated
Encephalomyelitis
2. *Acute Disseminated
Encephalomyelitis (ADEM)
*Is a rare inflammatory demyelinating
disease of the central nervous system.
http://myelitis.org/symptoms-conditions/acute-disseminated-encephalomyelitis
5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
2
3. *ADEM
*Is an autoimmune disorder in which the
body’s immune system mistakenly
attacks its own brain tissue, triggered by
an environmental stimulus in genetically
susceptible individuals
Lotze TE, Chadwick DJ. Acute disseminated encephalomyelitis in children: Pathogenesis, clinical features, and diagnosis. UpToDate. 2009
5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
3
4. *Epidemiology
ADEM
*Can occur at any age
* Mean age between 5 and 8 yr
* Slight male predominance
*Incidence : 0.07-0.4 per 100,000 per yr
in the pediatric population.
5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
4
5. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
5
*Post-infectious ADEM
*In approximately 50-75 percent of ADEM
cases, the inflammatory attack is preceded by
a viral or bacterial infection.
6. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
6
*Post-infectious ADEM (cont.)
* Large number of viruses associated with these
infections, including :
• Measles , Mumps, Rubella
• Varicella zoster, Epstein-Barr, Cytomegalovirus
• Herpes simplex, Hepatitis A, Influenza
• Enterovirus infections.
7. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
7
*Post-infectious ADEM(cont.)
* A seasonal distribution has been observed
showing that most ADEM cases occur in
the winter and spring
*The inflammatory attack and neurological
symptoms often begin within a couple of
weeks after the viral or bacterial illness.
8. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
8
*Post-immunization ADEM (cont.)
* Less than 5 percent of ADEM cases follow
immunization.
* The association between an inflammatory
attack following an immunization has been
temporal
* The direct connection between a
vaccination and an immune attack ?
9. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
9
*Post-immunization ADEM(cont.)
* Associated with immunization for:
•Rabies, Hepatitis B, Influenza
•Japanese B encephalitis
• Diphtheria /Pertussis / Tetanus
•Measles, Mumps , Rubella,
•Pneumococcus, Polio, Smallpox, and
Varicella.
10. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
10
*Post-immunization ADEM(cont.)
* Currently, the measles, mumps, and
rubella vaccinations are most commonly
associated with post- vaccinial ADEM.
*No infectious agent is isolated in most
cases.
11. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
11
*Post-immunization ADEM (cont.)
* The incidence of ADEM associated
with the live measles vaccination is 1 to
2 per million.
* Neurologic symptoms typically appear
4 to 13 days after a vaccination
12. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
12
* Categories of ADEM
1.Monophasic ADEM
*Any new or changing symptoms within this three
month period is considered as one event.
* Is a one-time episode that can develop over a
period for as long as three months.
* Symptoms that might occur during an oral steroid
taper or within one month of the completion of the
taper are also classified as one single episode.
13. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
13
* Categories of ADEM (cont.)
2. Recurrent ADEM
*Is defined as a subsequent attack that involves the
same symptoms that occurred during the initial
attack.
*The MRI findings tend to be similar to the initial
attack, and there are no lesions, but there could be
an enlargement of the lesions from the original
episode
14. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
14
* Categories of ADEM (cont.)
3. Multiphasic ADEM
*Is defined as an attack that involves new areas of the
central nervous system from the initial or previous
attacks.
*There must be signs of encephalopathy, but symptoms
and neuroimaging findings are in different areas from
the initial attack.
*There might be new lesions evident on MRI and there
might also be evidence of partial or complete resolution of
the lesions associated with the first episode
15. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
15
*
*The neurological signs from the inflammatory
attack often begin with:
Fever, Headache, and Vomiting
* Encephalopathy is a characteristic feature of
ADEM and usually develops rapidly.
16. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
16
* (cont.)
Encephalopathy results in symptoms, such as:
* Altered level of consciousness (lethargy →coma)
* Acute cognitive dysfunction
* Behavioral changes
* Seizures
In about ⅓ of those diagnosed.
17. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
17
* (cont.)
Other common neurologic signs of ADEM
include:
* Long tract pyramidal signs
*Acute hemiparesis
*Cerebellar ataxia
*Cranial neuropathies
18. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
18
*
*The diagnosis of ADEM is based on
clinical and radiologic characteristics
*There is no specific biologic marker or
confirmatory test to specifically identify
the disorder
19. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
19
* (cont.)
* An ADEM diagnosis is considered when
individuals develop multifocal neurologic
abnormalities with:
o Confusion
o Excessive irritability
oAltered level of consciousness
(encephalopathy)
Especially if the onset of symptoms occurs
within 1 to 2 weeks after a viral/bacterial
infection or a vaccination
20. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
20
*Axial T2-weighted FLAIR MRI
Axial T2-weighted
FLAIR MRI of the
brain in a child with
acute disseminated
encephalomyelitis
(ADEM).
21. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
21
*
*It is important to first consider a treatment with
antibiotics and/or acyclovir until an infectious
cause is ruled out
*A high dose of intravenous corticosteroids, for 3-5
days is the primary and most common first
treatment of ADEM
*Corticosteroids can be used concurrently with
antibiotics and acyclovir
22. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
22
*
*Plasma Exchange (PLEX) is recommended
if there is no response to corticosteroids.
*Intravenous immunoglobulin (IVIG) is
recommended if there is no response to
PLEX.
23. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
23
*
* Prognosis for most children with ADEM is
good
* Recovery is usually a slow process lasting
from four to six weeks
*The majority of children with ADEM make a
full recovery
24. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
24
*
* Between 60 to 90 percent are left with no
neurological deficits
* Those children who do have residual symptoms
are reported to have symptoms from:
* Transverse myelitis
* Recurrent headaches
* Behavioral problems
25. 5/18/2015
ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
25
*
*Long-term clinical follow-up and sequential
imaging by MRI are normally required to confirm
a diagnosis of ADEM.
* Development of a relapse with new lesions, it is not
compatible with a diagnosis of monophasic ADEM
*Depending on the clinical and imaging features, it
likely suggests the correct diagnosis being either
multiphasic ADEM or MS.
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ADEM Prof.Dr.Saad S Al Ani
Khorfakkan Hospital
26
*
*Lotze TE, Chadwick DJ. Acute disseminated encephalomyelitis
in children: Pathogenesis, clinical features, and diagnosis.
UpToDate. 2009
*Lotze TE, Chadwick DJ. Acute disseminated encephalomyelitis
in children: Prognosis and treatment. UpToDate. 2009.
*Yiu EM, Kornberg AJ, Ryan MM, et al.: Acute transverse
myelitis and acute disseminated encephalomyelitis in childhood:
spectrum or separate entities?. J Child Neurol. 24:287-296 2009