Acute disseminated encephalomyelitis in children: differential diagnosis from multiple sclerosis on the basis of clinical course

Lee, Yun Jin

A characteristic pattern of MS on MRI would include multiple well-demarcated lesions in the periventricular, juxtacortical, infratentorial, and spinal cord white matter. These areas of demyelination are best recognized using T2-weighted sequences. T2 FLAIR image sequences are the most sensitive in this evaluation, especially for periventricular lesions (Fig. 3) . T1-weighted sequences may reveal "black holes" that represent complete tissue loss resulting from a previous inflammatory event (Fig. 3) . Enhancement of active areas of inflammation and blood-brain barrier compromise can be seen using T1 gadolinium contrast sequences. Retrospective studies suggest that children with MS onset have more T2 bright lesions in the posterior fossa and more gadolinium-enhancing lesions than adults 27) . Further, the lesions in children were more likely to show reversibility on follow-up MRI than lesions in adults, suggesting better recovery of demyelination in children.