Acute disseminated encephalomyelitis (ADEM)

Case contributed by Heba Abdelmonem
Diagnosis almost certain


Sudden deterioration of the conscious level. History of viral influenza infection.

Patient Data

Age: 30 years
Gender: Female

Abnormal confluent regions of T2 and FLAIR high signal, situated in a sub-cortical location. Post contrast series reveal multiple scattered punctuate like enhancing lesions range in size from 4 mm to 8 mm. Abnormal high signal is demonstrated within both ADC map (not shown) and DWI denotes T2 shine through effect. No diffusion restriction. No involvement of the gray matter.

Case Discussion

Acute disseminated encephalomyelitis (ADEM) a monophasic autoimmune demyelinating disease of the central nervous system that occurs after a febrile infection or vaccination. Typically, ADEM manifests as multifocal high T2WI/ FLAIR signal lesions mimicking multiple sclerosis (MS). However, clinical and radiological findings may help in the differential. Patients with ADEM typically have at least two of the three following  

  1. They have symptoms not matching for MS: altered consciousness, hypersomnia, seizures, cognitive impairment, hemiplegia, quadriparesis, aphasia, or bilateral optic neuritis.
  2. They have no oligoclonal bands in cerebrospinal fluid sample.
  3. They involve the gray matter (basal ganglia or cortical lesions); corpus callosal involvement is less frequent in patients with ADEM than in those with MS.

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