Acute Disseminated Encephalomyelitis (ADEM): A Diagnosis of Exclusion with Atypical Neuroimaging

Abstract

Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin-the protective covering of nerve fibers. Although most often observed as a single episode, relapsing or recurrent forms are also present. The true incidence in Pakistan is still undetermined. ADEM is a diagnosis of exclusion in many cases, and relies on neuroimaging .We present a case of young female having no history of immunization recently with nonspecific symptoms (lower limbs weakness, fever that progress to all four limbs weakness with urine incontinence and aphasia). An atypical MRI finding of extensive abnormal areas in white matter involving frontopaietal and occipital lobes on T2 and FLAIR. ESR, C.T brain and L.P came normal which subsided young stroke and multiple sclerosis hence diagnosis of ADEM was made. She was subsequently treated with high-dose steroids (methylprednisolone) and plasmapheresis with good outcomes.