Acute Severe Encephalomyelitis: A Case Report and Literature Review

Abstract

Methods: A detailed report was provided on the diagnosis and treatment of an 11-year-and-9-month-old male patient, including clinical manifestations, laboratory tests (such as cerebrospinal fluid analysis and anti-NMDAR antibody testing), neuroimaging features (diffuse abnormal signals in brain parenchyma and spinal cord as shown by cranial and spinal MRI), and the response to immunotherapy. Based on a literature review, the characteristics of the disease and clinical experience were summarized. Results: The children had acute onset with fever, headache and vomiting as initial symptoms, and rapidly progressed to consciousness disorder, epileptic seizures and limb paralysis. The key auxiliary examinations indicated that the cerebrospinal fluid protein was significantly increased (3187 mg/L), inflammatory reaction was predominant with mononuclear cells (96%), and anti-NMDAR antibody was positive. Neuroimaging confirmed extensive involvement of the brain and spinal cord. The treatment involved intensive immunotherapy with early high-dose glucocorticoids combined with intravenous immunoglobulin (IVIG). During the treatment period, the patient developed respiratory failure and was transferred to the ICU. After multidisciplinary collaboration (intensive care medicine, neurology, infectious diseases, and rehabilitation) for active management of complications and enhanced rehabilitation therapy, the patient's condition improved.After 6 weeks of treatment, the child's neurological function was fully restored, and muscle strength returned to normal (Grade V). Long-term follow-up showed no sequelae in motor function, with good quality of life, enabling unimpeded participation in high-intensity sports activities such as basketball and middle-to long-distance running. Conclusion: Acute encephalomyelitis complicated by anti-NMDAR encephalitis is a critical condition. Early initiation of immunotherapy and enhanced multisystem monitoring are key to improving prognosis. Children exhibit strong neural plasticity, and timely intervention can significantly promote functional recovery. This case highlights the importance of autoantibody screening and individualized immunotherapy in acute extensive central nervous system injury, providing practical evidence for the comprehensive management of severe neuroimmune diseases.