Stephanie Angela Prijanto, Tikto Wahyono, Pipit Soesilowati


Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare, acute progressive autoimmune disease that occurs in the brain and spinal cord, in response to infection or immunization. Myelin autoantigens could share similar antigenic determinants with a pathogen and cross-react with a human’s antibody, causing demyelination of the nerve sheath. Identifying ADEM is essential to treat the patient and reduce any sequelae. Case description: An 11-year-old male was brought to the ER with one day of weakness of the face and the left side of the body. Along with that, the patient vomited, complained of headache and fever. One day prior, the patient received a Diphtheria-Pertussis-Tetanus Vaccination at his elementary school. A head computer tomography (CT) scan with contrast was done and showed multiple hypodense lesions in the bilateral internal capsule, bilateral lateral periventricular, subcortex of the right frontal lobe, and right cerebellum, with suspicion of ADEM. Discussion: There were many clinical signs of patients with ADEM, depending on the lesion. Brain and cerebellar lesions can cause irritability, confusion, coma, incoordination, and gait problems. Spine lesions can cause numbness and paralysis of the limbs. Lesions in the cranial nerve can cause dysarthria, blurry vision, double vision, and facial weakness. Conclusion: The prognosis for ADEM is good and often has improvement within a month. However, some patients need to undergo supportive therapy as appropriate. Further follow-up needs to be done to evaluate the disease progression, as ADEM may be manifesting as Multiphasic ADEM or any other demyelinating disease.

Save to Mendeley


ADEM; children; DPT Vaccination.

Full Text:



Stonehouse M, Gupte G, Wassmer E, Whitehouse W. P. Acute disseminated encephalomyelitis: Recognition in the hands of general pediatricians. Archives of Disease in Childhood. 2003;88(2):122–124.

Anilkumar AC, Foris LA, Tadi P. Acute Disseminated Encephalomyelitis. [Updated 2021 Sep 29]. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.

Krupp L, Tardieu M, Amato M, Banwell B, Chitnis T, Dale R, et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Multiple Sclerosis Journal. 2013;19(10):1261-1267.

Arktout S. Prognosis Factors in Children with ADEM: Clinical, Biological, and Radiological Features. International Journal of Radiology and Imaging Techniques, 2020;6(1).

Alroughani R, Boyko A. Pediatric multiple sclerosis: a review. BMC Neurol. 2018;18(1):27.

Huynh W, Cordato D, Kehdi E, Masters L, Dedousis C. Post-vaccination encephalomyelitis: Literature review and illustrative case. Journal of Clinical Neuroscience. 2008;15(12):1315–1322.

Granerod J, Davies N, Mukonoweshuro W, Mehta A, Das K, et al. Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement. Clinical Radiology. 2016;71(10):1050–1058.

Tawel HM, Elmehedwi IM, Ahmed FA. Acute Disseminated Encephalomyelitis (ADEM) in 6-year-old Libyan Boy: Case Report. Journal of Brain Behaviour and Cognitive Sciences. 2019;2(1):6.

Pohl D, Alper G, Haren K, et al. Acute disseminated encephalo-myelitis: Updates on an inflammatory CNS syndrome. American Academy of Neurology: Neurology.2016;87(2):S38-45.

Torisu H, Okada K. Vaccination-associated acute disseminated encephalomyelitis. Vaccine. 2019;37(8):1126–1129.

Tenembaum S, Chitnis, T, Ness J, Hahn S. Acute disseminated encephalomyelitis. American Academy of Neurology: Neurology.2007;68(2):S23-36.

Pohl D, Tenembaum S. Treatment of Acute Disseminated Encephalomyelitis. Current Treatment Options in Neurology. 2012;14(3):264–275.

Larassati H, Estiasari R, Yunus R, Parizel P. State-of-the-Art Review: Demyelinating Diseases in Indonesia. Multiple Sclerosis International. 2021.

Rare Neuroimmune Association. Acute disseminated encephalomyelitis (ADEM) Factsheet. Philadelphia: SRNA. 2021.

Steiner I, Kennedy P. Acute disseminated encephalomyelitis: current knowledge and open questions. Journal of NeuroVirology. 2015;21(5):473–479.

SRNA. 2021 RNDS | Acute Disseminated Encephalomyelitis (ADEM). [Video]. 2021. Available from: watch?v=uxFicEFUmk8 [Accessed December 10, 2021]