RT Book, Section
A1 Wu, Helen
A1 Fisher, Kristen
A2 Hershey, Andrew D.
SR Print(0)
ID 1195237730
T1 Demyelinating Diseases of the Central Nervous System
T2 CURRENT Diagnosis & Treatment Pediatric Neurology
YR 2023
FD 2023
PB McGraw Hill Education
PP New York, NY
SN 9781260457520
LK neurology.mhmedical.com/content.aspx?aid=1195237730
RD 2024/04/18
AB Acute  disseminated  encephalomyelitis  (ADEM)  is  a  central  nervous  system  (CNS)  inflammatory  syndrome  characterized  by  rapid-onset  encephalopathy  along  with  multifocal  neurologic  deficits.  While  ADEM  is  frequently  thought  to  occur  in  the  context  of  preceding  illness,  the  specific  microbial  trigger  is  rarely  identified,  and  the  pathophysiology  of  the  disorder  is  thought  to  be  immune-mediated.1  Magnetic  resonance  imaging  (MRI)  of  the  brain  typically  demonstrates  large,  diffuse,  and  poorly  demarcated  T2-hyperintense  lesions  predominantly  affecting  white  matter.  These  lesions  are  apparent  during  the  initial  acute  to  subacute  phase  (typically  3  months,  by  definition)  and  can  resolve  in  the  weeks  following.  Further  clinical  workup  includes  lumbar  puncture  (LP),  which  is  typically  remarkable  for  cerebrospinal  fluid  (CSF)  pleocytosis  with  lymphocytic  predominance  and  elevated  protein.  Additional  findings  may  include  elevated  immunoglobulin  (Ig)  G  index,  but  oligoclonal  bands  are  rarely  positive  in  ADEM.