Ophthalmologic manifestations in pediatric patients with acute disseminated encephalomyelitis

Introduction: Acute disseminated encephalomyelitis (ADEM) is an inflammatory syndrome affecting the central nervous system that often is associated with para-infectious causes. Optic neuritis is a common feature of this demyelinating disease, and a paucity of data regarding this entity exists in the ophthalmologic literature. Methods: We describe 10 pediatric patients with ADEM who presented at our institution between 1995 and 2003. Results: Six of these patients had optic neuritis, with visual acuities in the affected eyes ranging from 20/30 to light perception. Five of those with optic neuritis had bilateral disease. All patients were treated with high-dose methylprednisolone, and 4 of these patients had recovered with a visual acuity of 20/40 or better in the affected eyes. Two patients were lost to follow-up, and final visual acuities were not available. Nine of 10 patients had an identifiable preceding viral illness or immunization. Conclusions: ADEM is a known cause of optic neuritis in children and should be considered by the ophthalmologist treating this population of patients. All patients in this series were treated with high-dose intravenous steroids followed by an oral steroid taper and/or intravenous immunoglobulin. Final visual outcomes were favorable in all patients.