Presentation
Headache with fever, seizure and decreased level of consciousness. Treated for viral infection 15 days prior.
Patient Data
Multiple and bilateral supratentorial areas of T2 and FLAIR high signal involving the subcortical white matter mainly at parietal, frontal and posterior temporal regions with nodular enhancement on postcontrast sequences. The lesions are almost imperceptible on T1 and DWI. No hemorrhagic component seen on the GE sequence.
Both cerebellar hemispheres, brainstem, basal ganglia and thalami are spared.
Case Discussion
The patient'age, the clinical presentation and the MRI features are most consistent with an acute disseminated encephalomyelitis (ADEM).
Unfortunately, the child developed a myocarditis and passed away 48 hours later and the anti-MOG antibodies were not performed.
The association of ADEM and myocarditis was already discribed in the literature and usually due to a systemic autoimmune response of postinfectious origin with involvement of the brain and myocardium 1.