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Acute disseminated encephalomyelitis — SCE Neurology MCQ

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HardCNS inflammationAcute disseminated encephalomyelitisSCE Neurology

Ten days after a viral illness, a 7-year-old develops encephalopathy, ataxia and multifocal deficits. MRI shows large bilateral poorly demarcated white-matter and thalamic lesions; there was no prior attack. Which diagnosis best fits?

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Correct answer: A — Acute disseminated encephalomyelitis, in this clinical phenotype

The best answer is “Acute disseminated encephalomyelitis, in this clinical phenotype”. A first polyfocal demyelinating event with encephalopathy after infection and large bilateral lesions is the characteristic ADEM phenotype. “Relapsing-remitting multiple sclerosis” is plausible in a different neurological context, but the decisive findings here argue against it. “Subacute sclerosing panencephalitis” is plausible in a different neurological context, but the decisive findings here argue against it. “Posterior fossa neoplasm” is plausible in a different neurological context, but the decisive findings here argue against it. “Mitochondrial encephalopathy” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: International Paediatric Multiple Sclerosis Study Group ADEM criteria: https://pubmed.ncbi.nlm.nih.gov/18252895/