Abstract

ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) FOLLOWING PURIFIED CHICK-EMBRYO CELL ANTI-RABIES VACCINATION

Virendra C. Patil*, K. Sahoo, Amardip Rajput, Chinmay Kulkarni, Harsha V Patil

Abstract

Acute disseminated encephalomyelitis (ADEM) is an acute widespread demyelinating condition, which principally affects brain and spinal cord. It usually follows an infection or vaccination. The ADEM is a monophasic disease characterized by multifocal white matter lesions on neuroimaging. A case of post-vaccinial encephalitis after purified chick-embryo cell anti-rabies vaccination is presented for its rarity. We are reporting a case report of patient of 25 years old male presented with paraplegia with bladder retention and diplopia with exaggerated DTR and extensor plantar of acute onset with recent history of ARV vaccination. Cerebrospinal fluid examinations shows raised proteins and MRI imaging showed demyelinating lesions characteristic lesions seen on MRI appear as patchy areas of increased signal intensity on conventional T2-weighted images and on fluid attenuated inversion recovery sequence (FLAIR) predominantly seen in bilateral asymmetric parieral region, basal ganglion, thalamus, brain stem, cervical and thoracic cord with patchy distribution and skip lesions of ADEM in light of clinical scenario. The patient was treated with methylprednisonlone and responded well, diplopia, bladder involvement and paraplegia recovered over ten days.

Keywords: Post-vaccinial encephalitis Acute disseminated encephalomyelitis, antirabies vaccine, MRI, Methylprednisolone.