J Med Cases

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

Journal website http://www.journalmc.org

Case Report

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

Acute Disseminated Encephalomyelitis Responsive to Cyclophosphamide Therapy: A Case Report

Figures

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. 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. 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 series	Total sum area (cm²)	% Change compared to pre-cyclophosphamide (%)	Total sum area (cm²)	% Change compared to pre-cyclophosphamide (%)
Pre-cyclophosphamide	12.291	0	21.381	0
Two days post-cyclophosphamide	7.286	40.7	17.839	16.6
Two months post-cyclophosphamide	4.732	61.5	8.434	60.6

**Table 2.** Comparison of Functional Independence Measure (FIM) Score Ratings on Hospital Admission, Inpatient Rehab Admission, and Inpatient Rehab Discharge
FIM categories	FIM scores on hospital admission (May 22, 2013)	FIM scores on rehabilitation admission (August 9, 2013)	FIM scores on rehabilitation discharge (October 22, 2013)
Eating	1	1	5
Grooming	1	1	5
Bathing	1	1	3
Upper body dressing	1	1	4
Lower body dressing	1	1	1
Toileting	1	1	1
Bladder management	1	1	2
Bowel management	1	1	1
Bed to chair transfer	1	1	4
Toilet transfer	1	1	3
Tub transfer	1	1	3
Locomotion	1	1	5
Stairs	1	1	1
Cognitive comprehension	1	4	5
Expression	1	4	5
Social interaction	1	3	5
Problem solving	1	2	3
Memory	1	2	4
Total	18	28	60