Acute Disseminated Encephalomyelitis: Clinical, CSF, and MRI Findings and the Distinction from Multiple Sclerosis

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system usually developing in close temporal relationship to an infective illness or vaccination. This paper presents clinical, cerebrospinal fluid and MRI findings in ADEM and discusses the role of the MRI in the distinction of ADEM and MS.We reviewed the medical records, cerebrospinal fluid (CSF) and MRI studies of six consecutive patients diagnosed as having ADEM during a three-year period. All patients had CSF, including electrophoresis for demonstration of oligoclonal bands, and MRI studies in the acute stage; five patients repeated these examinations in the subacute and chronic stages.Four patients had clinical evidence of a multifocal neurological syndrome. In the two other cases there was clinical evidence only of transverse myelitis. The CSF was abnormal in all cases and showed a mild increase in cell count and protein. IgG synthesis and myelin basic protein were present in three patients. ...