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ADEM — RACP Adult Medicine MCQ

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ModerateNeurologyADEMRACP Adult Medicine

A 7-year-old boy presents with encephalopathy, bilateral optic neuritis, and multifocal white matter lesions on MRI following a viral illness. The lesions all enhance with gadolinium and appear to be of similar age. CSF shows pleocytosis. What is the most likely diagnosis?

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Correct answer: C — Acute disseminated encephalomyelitis

ADEM is a monophasic demyelinating illness typically occurring in children post-infection. Key distinguishing features from MS include: encephalopathy (required for diagnosis), multifocal lesions of similar age (same gadolinium enhancement phase), and typically monophasic course. It is treated with high-dose IV methylprednisolone.

Reference: ABN – 2024 – Demyelination Guidelines