Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children

Neurology. 2001 May 22;56(10):1308-12. doi: 10.1212/wnl.56.10.1308.


Objective: To identify the clinical and neuroradiologic features of acute disseminated encephalomyelitis (ADEM) in childhood.

Methods: A retrospective review was conducted of the medical records and MRI of children who presented to the Royal Children's Hospital in Melbourne with ADEM between January 1993 and December 1998.

Results: Of the 31 patients included in this study, 22 (71%) experienced a prodromal illness. Two patients (6%) had received hepatitis B vaccine 3 to 6 weeks before developing their illness. Symptoms and signs typically evolved over several days. Ataxia was the most common presenting feature, occurring in 20 patients (65%). MRI findings were variable, but lesions were most commonly seen bilaterally and asymmetrically in the frontal and parietal lobes. The authors found a high incidence of the corpus callosal and periventricular changes more typically associated with MS, but they also found a high rate of deep gray matter involvement (61% of patients). The use of high-dose IV methylprednisolone was usually associated with rapid recovery. Eighty-one percent of patients recovered completely, with only mild sequelae recorded in the remaining children.

Conclusion: In the absence of a biological marker, the distinction between ADEM and MS cannot be made with certainty at the time of first presentation, but the authors suggest that a viral prodrome, early-onset ataxia, high lesion load on MRI, involvement of the deep gray matter, and absence of oligoclonal bands are more indicative of ADEM.

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects
  • Brain / immunology
  • Brain / pathology*
  • Brain / physiopathology*
  • Central Nervous System Viral Diseases / immunology
  • Central Nervous System Viral Diseases / pathology
  • Central Nervous System Viral Diseases / physiopathology
  • Child
  • Child, Preschool
  • Encephalomyelitis, Acute Disseminated / drug therapy
  • Encephalomyelitis, Acute Disseminated / pathology*
  • Encephalomyelitis, Acute Disseminated / physiopathology*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / adverse effects
  • Predictive Value of Tests
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Methylprednisolone