Coexistence of Transverse Myelitis and Acute Disseminated Encephalomyelitis; a rare case

Background: Transverse myelitis (TM) is a disease in which motor, sensory and autonomic dysfunction develops as a result of localized inflammation of the spinal cord. Acute disseminated encephalomyelitis (ADEM) is a disease of sudden onset and variable clinical course characterized by demyilination of the central nervous system. Although ADEM and TM are separate entities clinically and radiologically, they have many similarities in terms of treatment and rehabilitation approach. Case report: A 14-year-old female patient applied to the emergency service with the complaints of lowback pain, weakness in the legs, stumbling and falling. In addition to the paraplegia clinic, there were sensory defect, urinary retention and loss of control of the anal sphincter. ADEM and TM were diagnosed by considering the differential diagnoses due to demyelinating plaques seen in cranial and spinal MRI examinations. High-dose methyl prednisolone and IVIG were given for treatment. After this treatment, dorsiflexion muscle strength of both ankles improved to 2/5. After starting the rehabilitation program, it was observed that there was a gradual improvement in muscle strength. At the end of the 3rd month, the patient was able to walk independently without support, urinate spontaneously and easily do her daily work. Conclusion: Despite the poor prognostic factors, we achieved very good results with an effective medical treatment and rehabilitation program in our case with the association of ADEM and TM, which we encountered as a rare condition. We hope that our case will contribute to the literature on the importance of rehabilitation.