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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 co rpus 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. 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. |
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acute disseminated encephalomyelitis
ataxia
cerebrospinal fluid,oligoclonal IgG in
children
gray matter
misdiagnosis
MRI
MRI,abnormal
MRI,disappearing lesion on
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multiple sclerosis
multiple sclerosis,differential diagnosis of
multiple sclerosis,misdiagnosis
neurologic disease,diagnoses of
prognosis
review article
steroid
steroid therapy,CNS treatment and complications with
treatment of neurologic disorder
viral infection
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