Faisal A, Tariq Z, Latif RU, Amir S, Basit A, Basil AM. Silent triggers and symmetric peduncles - a rare presentation of adult-onset acute disseminated encephalomyelitis: A case report. World J Clin Cases 2025; 13(30): 112419 [DOI: 10.12998/wjcc.v13.i30.112419]
Corresponding Author of This Article
Abdul M Basil, MD, Department of Medicine, Spinghar Medical University, 4th Alley, Char Rahe Qambar Kabul, Kabul 1001, Kābul, Afghanistan. abdulmaboodbasil@outlook.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2025; 13(30): 112419 Published online Oct 26, 2025. doi: 10.12998/wjcc.v13.i30.112419
Silent triggers and symmetric peduncles - a rare presentation of adult-onset acute disseminated encephalomyelitis: A case report
Affan Faisal, Zain Tariq, Rania Usman Latif, Saim Amir, Abdul Basit, Abdul M Basil
Affan Faisal, Zain Tariq, Rania Usman Latif, Saim Amir, Abdul Basit, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Abdul M Basil, Department of Medicine, Spinghar Medical University, Kabul 1001, Kābul, Afghanistan
Author contributions: Faisal A contributed to conceptualization; case management; manuscript writing – original draft; Latif RU contributed to literature review; manuscript editing; data interpretation; Tariq Z contributed to MRI analysis; image selection and figure preparation; critical review; Amir S contributed to clinical data curation; patient follow-up; writing – case presentation; Basit A contributed to Laboratory findings interpretation; serology review; manuscript review; Basil AM contributed to supervision; final manuscript approval; critical revision for intellectual content.
Informed consent statement: Written informed consent obtained for publication, including anonymized data and images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdul M Basil, MD, Department of Medicine, Spinghar Medical University, 4th Alley, Char Rahe Qambar Kabul, Kabul 1001, Kābul, Afghanistan. abdulmaboodbasil@outlook.com
Received: July 27, 2025 Revised: August 3, 2025 Accepted: August 22, 2025 Published online: October 26, 2025 Processing time: 76 Days and 19.4 Hours
Abstract
BACKGROUND
Acute disseminated encephalomyelitis (ADEM), which is rare, primarily affects children. It usually manifests as acute encephalopathy and multifocal neurological impairments after infection or vaccination. Diagnosis is still difficult due to the clinical and radiological similarity to other central nervous system disorders. Adult-onset ADEM calls for thorough reporting in order to improve diagnosis and treatment.
CASE SUMMARY
A 55-year-old man with hypertension had a high fever, intense headache and a steady decline in his neurological function after two weeks. Left facial paralysis was the initial symptom, which progressed to left hemiparesis, reduced consciousness level, photophobia, phonophobia, vomiting, and a focal seizure in the right leg. He had no history of autoimmune disease, vaccinations, or infections. Investigations showed negative infectious/autoimmune serology, mild cerebrospinal fluid lymphocytic pleocytosis (protein 76 mg/dL), and lymphopenia. Brain magnetic resonance imaging without contrast revealed bilateral, symmetrical T2/fluid-attenuated inversion recovery hyperintensities, primarily in the middle cerebellar peduncles, with minor involvement in the pontine and periventricular regions. Neoplastic, metabolic, vascular, and infectious conditions were not included. The patient showed spontaneous neurological improvement by Week 3 with near-complete motor recovery (limb strength 4/5) after methylprednisolone and rehabilitation, despite logistical delays in starting immunotherapy. The monophasic course and radiological/clinical remission were supported by idiopathic ADEM.
CONCLUSION
This case shows an uncommon, idiopathic, cerebellar-predominant ADEM variation in an adult without conventional triggers. It emphasizes the diagnostic difficulty in distinguishing ADEM from mimics (such as stroke or infection) in adults. Spontaneous improvement before treatment, although early detection is still crucial, should be highlighted, although early detection is still crucial. Increased clinician awareness, fair access to neuroimaging, and focused research on adult ADEM are crucial to fill these gaps and improve outcomes in places with limited resources.
Core Tip: Acute disseminated encephalomyelitis (ADEM) is typically a pediatric, post-infectious demyelinating disease of the central nervous system. We report a rare case of idiopathic, adult-onset ADEM in a 55-year-old man with no preceding infection, vaccination, or autoimmune history. This case underscores the diagnostic complexity of ADEM in older adults, particularly when presenting with atypical symptoms and radiological findings. Early recognition and a high index of suspicion are critical for timely intervention, even in resource-limited settings. Our findings emphasize the need to broaden diagnostic considerations for encephalopathy and multifocal neurological deficits in adults.
