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Título

ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) AFTER COVID-19 INFECTION: CASE REPORT

RESUMO

Case presentation: Woman, 56 years old, with a previous history of infection by covid-19 for a month. Denies smoking, alcoholism or drug addiction, works in an accounting office, goes to the emergency service with a report that 24 hours ago she started left hemihypoesthesia and left rhyme deviation, with no additional complaints. On neurological physical examination, the patient has right peripheral facial palsy and left hemihypoesthesia. During the investigation of the case, computed tomography did not show any changes. Brainstem audiometry (BERA) showed bilateral retrocochlear dysfunction. CSF with a slight increase in protein. Magnetic resonance imaging (MRI) showed a right paramedian image at the medulla-pontine transition, without expansive or atrophic features. Raising the hypothesis of acute disseminated encephalomyelitis (ADEM). We started pulse therapy with methylprednisolone 1g/day for 05 days. The patient evolved in good general condition, eupneic, phasic, conscious and oriented; also reports improvement in the sensation of paresthesia in the left side and of facial paralysis. Discussion: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating condition of the central nervous system, which is usually caused by viral infections, however, it can also be triggered by vaccines or not have an apparent cause. Although its incidence is not fully known, it is known that it is an uncommon disease in adults, occurring more frequently in children. The classic picture of ADEM occurs, on average, 26 days after an infectious condition, manifesting itself with acute multifocal neurological symptoms, often evolving with vertiginous deterioration. Most patients have motor and/or sensory deficits, which may be accompanied by other signs and symptoms such as headache, malaise, ataxia, aphasia and nystagmus. The diagnosis is made from clinical presentation and history, neuroimaging and CSF analysis. The prognosis of the patients with ADEM is mostly favorable, with total or almost complete recovery after approximately 6 months of presentation. Final comments: Thus, this clinical case is uncommon due to the low frequency of ADEM after infections, especially in adults. In addition, this is a rare manifestation resulting from COVID-19 infection, and it can be a condition that leaves sequelae.