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Acute disseminated encephalomyelitisin the intensive care unit:clinical features and outcome of 20 adults

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Abstract

Objective

Because acute disseminated encephalomyelitis (ADEM) is a rare disease in adults admitted to the intensive care unit (ICU), we describe its characteristics and patient outcomes.

Design and setting

A retrospective (2000–2006), observational, multicenter study was conducted in seven medical ICUs. Clinical, biological and neuroimaging features of patients diagnosed with ADEM were evaluated. Functional prognosis was graded using the modified Rankin (mR) scale.

Interventions

None.

Measurements and results

At ICU admission, the 20 patients' median (25th–75th percentile) Glasgow coma score (GCS) was 7 (4–13), temperature 39 (38–39) °C. Six (30%) patients had seizures, 17 (85%) had a motor deficit and 14 (70%) required mechanical ventilation. Fifteen (75%) patients had cerebrospinal fluid pleocytocis. All patients had white-matter lesions on their magnetic resonance images. All patients received high-dose steroids. Five (25%) patients died. Fourteen (70%) patients were able to walk without assistance (mR ≤ 3) at follow-up [7 (3–9) months]. Compared to the latter, patients who died or were severely disabled at the follow-up evaluation [6 (30%) patients, mR > 3] had significantly lower GCS (4 (3–4) vs. 12 (7–13), p = 0.002) and more frequent seizures [4 (67%) vs. 2 (14%), p = 0.02] at admission.

Conclusions

Unlike previous reports, our results showed that ADEM requiring ICU admission is a severe disease causing high mortality, and 35% of the patients had persistent functional sequelae. Intensivists should be aware of ADEM's clinical features to initiate appropriate immunomodulating therapy.

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Acknowledgements

We are indebted to Mrs. Janet Jacobson for technical assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat–Claude Bernard, AP–HP, Université Paris 7, 46, rue Henri Huchard, 75877, ParisCedex 18, France

    Romain Sonneville, Lila Bouadma, Bruno Mourvillier, Bernard Regnier & Michel Wolff

  2. Service de Neurologie I, Groupe Hospitalier Pitié–Salpêtrière, AP–HP, Université Paris 6, 47, boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Sophie Demeret & Francis Bolgert

  3. Service de Radiologie, Hôpital Bichat–Claude Bernard, AP–HP, Université Paris 7, 46, rue Henri Huchard, 75877, ParisCedex 18, France

    Isabelle Klein

  4. Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, AP–HP, Université Paris 5, 20, rue Leblanc, 75908, Paris Cedex 15, France

    Juliette Audibert

  5. Service de Réanimation Médicale, Hôpital Saint-Louis, AP–HP, Université Paris 7, 1, avenue Claude Vellefaux, 75475, Paris Cedex 10, France

    Stéphane Legriel

Authors
  1. Romain Sonneville
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  2. Sophie Demeret
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  3. Isabelle Klein
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  4. Lila Bouadma
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  5. Bruno Mourvillier
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  6. Juliette Audibert
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  7. Stéphane Legriel
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  8. Francis Bolgert
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  9. Bernard Regnier
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  10. Michel Wolff
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Corresponding author

Correspondence to Romain Sonneville.

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Sonneville, R., Demeret, S., Klein, I. et al. Acute disseminated encephalomyelitisin the intensive care unit:clinical features and outcome of 20 adults. Intensive Care Med 34, 528–532 (2008). https://doi.org/10.1007/s00134-007-0926-2

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  • DOI: https://doi.org/10.1007/s00134-007-0926-2

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