PT  - JOURNAL ARTICLE
AU  - J.L. Hynson
AU  - A.J. Kornberg
AU  - L.T. Coleman
AU  - L. Shield
AU  - A.S. Harvey
AU  - M.J. Kean
TI  - Clinical and neuroradiologic features of acute disseminated encephalomyelitis in children
AID  - 10.1212/WNL.56.10.1308
DP  - 2001 May 22
TA  - Neurology
PG  - 1308--1312
VI  - 56
IP  - 10
4099  - http://n.neurology.org/content/56/10/1308.short
4100  - http://n.neurology.org/content/56/10/1308.full
SO  - Neurology2001 May 22; 56
AB  - 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.