DIFFERENTIAL DIAGNOSIS OF ACUTE DIFFUSE ENCEPHALOMYELITIS (ADEM) AND MULTIPLE SCLEROSIS (MS) - CASE REPORT
Abstract
Acute Disseminated Encephalomyelitis (ADEM) is an acute, immune-mediated demyelinating disorder of the central nervous system, primarily affecting children between 3 and 7 years of age. It typically occurs 1–3 weeks after a viral, bacterial, or post-vaccination infection. Clinically, it presents with multifocal neurological deficits and encephalopathy, which may include altered consciousness, seizures, or cognitive disturbances. MRI shows widespread demyelinating lesions, mainly in the subcortical white matter. Laboratory findings may include elevated CRP, ESR, leukocytosis, and CSF pleocytosis. Treatment involves high-dose intravenous corticosteroids, with intravenous immunoglobulin or plasma exchange used in severe or refractory cases. Though usually monophasic, up to 25% of patients may experience relapses. Some children may require ICU care and early rehabilitation to address cognitive, motor, or speech deficits, highlighting the importance of timely diagnosis and management.
References
A. C. Anilkumar, L. A. Foris, and P. Tadi, “Acute Disseminated Encephalomyelitis,” StatPearls, Jan. 2024, Accessed: Apr. 04, 2024. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK430934/
Krupp, Lauren B et al. “International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions.” Multiple sclerosis (Houndmills, Basingstoke, England) vol. 19,10 (2013): 1261-7. doi:10.1177/1352458513484547
Paolilo, Renata Barbosa et al. “Acute Disseminated Encephalomyelitis: Current Perspectives.” Children (Basel, Switzerland) vol. 7,11 210. 3 Nov. 2020, doi:10.3390/children7110210
Massa, Serena et al. “Update on Acute Disseminated Encephalomyelitis in Children and Adolescents.” Children (Basel, Switzerland) vol. 8,4 280. 6 Apr. 2021, doi:10.3390/children8040280
Otallah, Scott. “Acute disseminated encephalomyelitis in children and adults: A focused review emphasizing new developments.” Multiple sclerosis (Houndmills, Basingstoke, England) vol. 27,8 (2021): 1153-1160. doi:10.1177/1352458520929627
Cole, Jordan et al. “Acute Disseminated Encephalomyelitis in Children: An Updated Review Based on Current Diagnostic Criteria.” Pediatric neurology vol. 100 (2019): 26-34. doi:10.1016/j.pediatrneurol.2019.06.017
Wang, Cynthia X. “Assessment and Management of Acute Disseminated Encephalomyelitis (ADEM) in the Pediatric Patient.” Paediatric drugs vol. 23,3 (2021): 213-221. doi:10.1007/s40272-021-00441-7
Practical Neurology. "Paediatric multiple sclerosis (PSM)." Available online: https://neurologia-praktyczna.pl/a6054/Pediatryczne-stwardnienie-rozsiane--PSM-.html
Gołąbek, Violetta et al. “Acute disseminated encephalomyelitis in children as the result of aseptic meningitis - a report of two cases”. Polish neurology and neurosurgery vol. 45,2 (2011): 180-7. doi:10.1016/s0028-3843(14)60031-1 10. Practical Neurology. "Acute disseminated encephalomyelitis (ADEM)." Available online: https://neurologia-praktyczna.pl/a1323/Ostre-rozsiane-zapalenie-mozgu-i-rdzenia--ADEM-.html
Dale RC, Branson JA. Acute disseminated encephalomyelitis or multiple sclerosis: can the initial presentation help in establishing a correct diagnosis?. Arch Dis Child. 2005;90(6):636-639. doi:10.1136/adc.2004.062935
Alper G, Heyman R, Wang L. Multiple sclerosis and acute disseminated encephalomyelitis diagnosed in children after long-term follow-up: comparison of presenting features. Dev Med Child Neurol. 2009 Jun;51(6):480-6. doi: 10.1111/j.1469-8749.2008.03136.x. Epub 2008 Oct 24. PMID: 19018840; PMCID: PMC2704249.
Wattjes MP, Steenwijk MD, Stangel M. MRI in the Diagnosis and Monitoring of Multiple Sclerosis: An Update. Clin Neuroradiol. 2015;25 Suppl 2:157-165. doi:10.1007/s00062-015-0430-y
Views:
86
Downloads:
21
Copyright (c) 2025 Marcin Narloch, Marcelina Kurek, Weronika Skrzypek, Szymon Skrzypek, Natalia Domańska, Wiktoria Garbacz , Anna Gryc, Zuzanna Rabczak
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
