Case of the Month: October, 2010 Page 3

Answer: All of the above

Case Findings

Multiple bilateral cerebral hemispheric FlAIR hyperintensities which demonstrate peripheral enhancement, predominately on the white matter side of the lesions. No restricted diffusion.

Diagnosis

Biopsy proven ADEM

Acute Disseminated Encephalomyelitis

• Multifocal neurologic symptoms, usually 10-14 days after infection/vaccination
• Multifocal white matter/basal ganglia lesions are generally seen
• Initial CT is normal in  40%
• Punctate, ring, incomplete ring, peripheral enhancement
• May appear identical to MS
• Clinical symptoms are usually monophasic and self limited
• Typically delay between onset of clinical symptoms and imaging findings
• Microscopic features: myelin breakdown,  perivenous inflammation
• Children with greater incidence than adults, male predominance
• Treatment: Immunomodulary therapy

References

1. Dale RC: Acute disseminated encephalomyelitis. Semin Pediatr Infect Dis.14(2): 90-5,2003
2. Rust RS: Multiple Sclerosis, acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis,  and multiple sclerosis in children. Brain. 123 Pt. 12:2407
3.  Garg RK: Acute disseminated encephalomyelitis. Postgrad Med J. 79 (927): 11-7. 2003