Question

Acute disseminated encephalomyelitis (ADEM): Diagnosis.

Hint:

MRI with contrast is crucial in diagnosing ADEM, as it reveals the characteristic demyelinating lesions that help differentiate it from other conditions.

Answer 1

Step 1: Diagnosis of ADEM.
The diagnosis of ADEM is primarily clinical, supported by imaging and laboratory findings. Key steps in diagnosis include:
(1) Clinical History: Recent history of viral infection (e.g., measles, mumps, or varicell or vaccination (e.g., MMR, influenz preceding neurological symptoms.
(2) Neurological Examination: The physical examination often reveals multifocal neurological signs, including motor deficits, sensory changes, and cerebellar involvement.
(3) Magnetic Resonance Imaging (MRI): The gold standard for diagnosing ADEM. MRI typically shows multiple, asymmetric, hyperintense lesions on T2-weighted images, often involving the white matter of the brainstem, cerebellum, and periventricular areas.
(4) Cerebrospinal Fluid (CSF) Analysis: Mild pleocytosis (increased white blood cells) and elevated protein levels may be found, but the CSF typically remains normal.
(5) Exclusion of Other Conditions: ADEM is a diagnosis of exclusion, so other conditions like multiple sclerosis, encephalitis, or acute viral infections should be ruled out.