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

Lee, Yun Jin

In the spinal cord, large confluent intramedullary lesions that extend over multiple segments are common 3, 12) , and the degree of contrast enhancement is variable. Abnormal findings on MRI may progress over a relatively short period of time, consistent with progression of the disease. Sequential imaging by MRI is sometimes required to confirm the diagnosis of ADEM, as the occurrence of relapses, with new lesions on MRI, is not compatible with a diagnosis of monophasic ADEM, and suggests that the correct diagnosis is either multiphasic ADEM or MS, based upon the clinical symptoms and neuroimaging findings 4) . Analysis of CSF reveals pleocytosis and/or increased protein concentration in the majority of patients with ADEM 1,2) . However, the CSF can also be normal. Oligoclonal bands in CSF are seen in some patients with ADEM, but are a nonspecific finding more often associated with multiple sclerosis. Evaluation for infectious agents includes viral cultures of samples from the throat and nasopharynx, stool, and CSF, and serologic testing for influenza, Epstein-Barr virus, herpes, varicella, mycoplasma, cytomegalovirus, and rubella. These studies are rarely positive 12) .