Acute Disseminated Encephalomyelitis Presenting With Paraplegia and a Neurogenic Bladder: A Case Report and Brief Literature Review.

This is a single-patient report, so it describes what happened to this boy rather than what will happen to most children. Several treatments were given together, including methylprednisolone, acyclovir, ceftriaxone, clean intermittent catheterization, lower-limb motor rehabilitation, Stoller afferent nerve stimulation and pelvic floor muscle training, so the contribution of any single cannot be separated. Natural recovery in ADEM may account for much of the improvement. There was no control group or comparison treatment. MRI was limited by artifacts from fixed orthodontic appliances, and diffusion-weighted imaging was nondiagnostic. The CSF report says no pleocytosis but also lists 75 cells/µL. The literature search found only 3 relevant case reports describing urinary symptoms, all focused on acute management. Access to neuromodulation may vary by center. MRI suggested an inflammatory demyelinating process such as ADEM or MOG-associated disease, but infectious etiology could not be entirely excluded, and anti-MOG and anti-AQP4 antibodies were negative.

The authors declared no conflicts of interest.

Do not conclude that catheter training, leg rehabilitation, tibial nerve stimulation or pelvic floor work caused the recovery. The boy also received methylprednisolone, acyclovir and ceftriaxone, and ADEM can improve naturally, so the effect of any single treatment cannot be separated.