Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 6, Number 7, July 2015, pages 290-294


Acute Disseminated Encephalomyelitis Responsive to Cyclophosphamide Therapy: A Case Report

Figures

Figure 1.
Figure 1. Comparison of brain MRI T2 FLAIR axial images demonstrating hyperintense areas of demyelination. (A) Four hyperintense demyelinating lesions, a total sum area of 21.381 cm2, upon admission to hospital. (B) Three demyelinating lesions with decreased hyperintensity and total sum area of 17.839 cm2, a 16.6% decrease in area compared to (A) 2 days after receiving a 3-day course of IV cyclophosphamide 1,000 mg/m2. (C) Three demyelinating lesions with further decreased hyperintensity and total sum area of 8.434 cm2, a 60.6% decrease in total sum area compared to (A) 2 months after receiving cyclophosphamide.
Figure 2.
Figure 2. Comparison of brain MRI T2 FLAIR sagittal images demonstrating hyperintense areas of demyelination. (A) Three well demarcated hyperintense demyelinating lesions, a total sum area of 12.291 cm2, upon admission to hospital. (B) Two demyelinating lesions with decreased hyperintensity and total sum area of 7.286 cm2, a 40.7% decrease in area compared to (A) 2 days after receiving a 3-day course of IV cyclophosphamide 1,000 mg/m2. (C) Two demyelinating lesions with further decreased hyperintensity and total sum area of 4.732 cm2, a 61.5% decrease in total sum area compared to (A) 2 months after receiving cyclophosphamide.
Figure 3.
Figure 3. Timeline of clinical presentation, interventions, and outcomes.

Tables

Table 1. Comparison of Total Sum Area and % Change of Lesion Area Pre- and Post-Cyclophosphamide Therapy
 
Brain MRI T2 FLAIR seriesTotal sum area (cm2)% Change compared to pre-cyclophosphamide (%)Total sum area (cm2)% Change compared to pre-cyclophosphamide (%)
Pre-cyclophosphamide12.291021.3810
Two days post-cyclophosphamide7.28640.717.83916.6
Two months post-cyclophosphamide4.73261.58.43460.6

 

Table 2. Comparison of Functional Independence Measure (FIM) Score Ratings on Hospital Admission, Inpatient Rehab Admission, and Inpatient Rehab Discharge
 
FIM categoriesFIM scores on hospital admission (May 22, 2013)FIM scores on rehabilitation admission (August 9, 2013)FIM scores on rehabilitation discharge (October 22, 2013)
Eating115
Grooming115
Bathing113
Upper body dressing114
Lower body dressing111
Toileting111
Bladder management112
Bowel management111
Bed to chair transfer114
Toilet transfer113
Tub transfer113
Locomotion115
Stairs111
Cognitive comprehension145
Expression145
Social interaction135
Problem solving123
Memory124
Total182860