Life-saving hemicraniectomy for fulminant acute disseminated encephalomyelitis

Abstract

Fulminant acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disorder, which most often occurs after an infection or vaccination. It frequently presents with focal neurologic signs and an altered sensorium. Patients often require critical care for airway management but are typically treated with medical therapy alone, including intravenous steroids and other immunotherapies. We present a case of dominant hemisphere fulminant ADEM in a patient who required neurosurgical intervention and a life-saving hemicraniectomy despite maximum medical therapy.

Key words:

• Acute disseminated encephalomyelitis
• hemicraniectomy
• cerebral herniation
• dominant hemisphere

Acknowledgements

The authors thank Roger McLendon, MD, for providing the pathology slides for this case report.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.