What is the role of lumbar puncture in the workup of acute disseminated encephalomyelitis (ADEM)?

Updated: Nov 08, 2018
  • Author: J Nicholas Brenton, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

The lumbar puncture is an essential aspect of acute disseminated encephalomyelitis (ADEM) workup. [17] It assists in distinguishing ADEM from various forms of meningoencephalitis, especially upon the basis of titers for the various bacteria, viruses, or other agents that may produce a directly infectious form of meningoencephalitis.

  • The immune profile is also helpful in distinguishing ADEM from MS. The IgG index, IgG synthetic rate, or oligoclonal bands are positive in more than two thirds of all first clinically recognized MS bouts and in 90-98% of individuals who have experienced multiple MS bouts. One or more of these studies is positive in a minority of ADEM cases.

  • Note that the findings on immune profile studies may be positive in various infectious conditions such as neurosyphilis, subacute sclerosing panencephalitis (SSPE), Lyme disease, stroke, and various forms of acute or chronic bacterial or viral meningoencephalitis. The CSF:serum IgG index or synthetic rate formulations may show positive results in neurosyphilis, Lyme disease, Guillain-Barré syndrome, some brain tumors, sarcoid, and a wide variety of bacterial or viral meningoencephalitides or other forms of CNS inflammation.

Occasionally, brain biopsy is necessary to distinguish ADEM from other diagnostic possibilities. The diagnosis of ADEM is confirmed when typical perivenular demyelinating changes with axonal sparing are observed. [47, 85]


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