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Acute Disseminated Encephalomyelitis in an Incarcerated Adolescent Presents as Acute Psychosis

Case Report and Literature Review

Neeki, Michael M., DO, MS, FACEP; Au, Christine, BA; Richard, Aurora, DO; Peace, Carlos, RN; Jaques, Sharon, RN; Johansson, Jens, DO

doi: 10.1097/PEC.0000000000000919
Illustrative Cases
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Objective We aimed to describe a case of an incarcerated adolescent with acute disseminated encephalomyelitis (ADEM) presenting as acute psychosis.

Methods This was a retrospective case report followed with chart and literature review.

Main Findings An adolescent with ADEM presented with drastic behavior and personality changes that led to her incarceration for serious charges. Acute disseminated encephalomyelitis leads to neuropsychiatric effects and can be seen with magnetic resonance imaging as a large mass effect that may result in a poor prognosis. This adolescent made a full recovery from her left facial droop, slurred speech, and left-sided hemiplegia, and her personality changes were reverted.

Conclusions Acute disseminated encephalomyelitis can present as acute psychosis; therefore, clinical suspicion is important when treating patients who have a history of past infectious brain diseases, especially encephalitis. Given the rapid onset of disease, physicians must be knowledgeable of the diagnosis and treatment of ADEM and be vigilant in finding organic causes of acute psychosis.

From the Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA.

Sharon Jaques RN is deceased.

Disclosure: The authors declare no conflict of interest.

Reprints Christine Au, Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N Pepper Avenue, Colton, CA 92324 (e-mail: au.christine.k@gmail.com).

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