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| Question : |
2 yr male child referred to me as a case ,with h / o fever 5 days altered sensorium 4 days,unconsciousness 3 days? Seizure. On exam I found RT facil palsy and rt ul monoparesis, neck rigidity was positive,b/l planter upgoing, b/l pupil dialuted? Due to Mydriatricsatropine ointment applied,,fundus was wnlresponding poorly to deep painful stimuli. Other system wnl.i kept the possibility of adem. I kept on i/v cefipime ,amikacin,mannitol .. Investgation were widal -ve,mp -ve csf 10 lymphos,protein 96,ct 1 hypodense lesion on parieto occiptal region,next day develop lt ll paresis.mri repport on next day was s/o of adem.i started methyl pred pulse therapy ,ialso added acyclovir.child showed improvement on 3rd day,now 7th day of admission,he is movinng all limbs,facil improved,accepting orally well,my worry is he is not speaking and visual perception is also poor,pupil still dilated,i am tapering steroid,my plan to taper prednisolone in next 8 days,to complete acyclovir 10days,cefi pime 14 days.my? How long ican wait for reconery,or any other help ? |
Answer |
A child with ADEM may need steroids for a long time till there are reversal of MRI findings. Stopping the steroids in a short time may lead to relapse and recurrence of symptoms. Also if you are suspecting viral encephalitis especially herspes, an EEG would be useful to looks for pleds. Pupils may remain dilated for 2-3 weeks after atropine. Since visual perception is poor, one should evaluate whether it is a cortical involvement or problem in the pathway by doing a VEP if required. If cortical, due to plaques in the occipital lobe, steroids may be required for a very long time. It is ideal that a neurologist evaluates him for the ADEM. |
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