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Weston-Hurst syndrome: a rare fulminant form of acute disseminated encephalomyelitis (ADEM)
  1. Sumaira Nabi,
  2. Mazhar Badshah,
  3. Shahzad Ahmed,
  4. Ali Zohair Nomani
  1. Department of Neurology, PIMS, Islamabad, Pakistan
  1. Correspondence to Dr Sumaira Nabi, sumairafn{at}


A 25-year-old Pakistani woman presented to the emergency department with a 2-day history of rapidly progressive tetraplegia followed by sudden loss of consciousness. This was preceded by an upper respiratory tract infection. On examination, she was deeply comatose with a GCS of 3/15 and intact brainstem reflexes. She was in respiratory distress, and an endotracheal tube had been passed. She had flaccid quadriplegia with depressed deep tendon reflexes and upgoing plantar response. Her MRI brain with contrast showed extensive brainstem involvement with haemorrhagic foci along with signal changes in the corpus callosum. The patient was put on a respirator. She was given IV methyl prednisolone, and later on 5 sessions of plasmapheresis were performed. After 3 months, the patient gradually recovered and started communicating. Her motor power had improved to 2/5 in her arms and 1/5 in the lower extremities. She was then discharged for further rehabilitation at home.

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  • Contributors All the authors contributed equally to this work. All the authors meet the criteria for authorship as established by ICMJE. Conception or design of the work- SN, MB, SA, AZN. Data collection- SN, MB, SA, AZN. Drafting the article- SN, MB, SA, AZN. Critical revision of the article- SN, MB, SA, AZN. Final approval of the version to be published-SN, MB, SA, AZN.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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