Abstract
Acute disseminated encephalomyelitis (ADEM) is a commonly encountered inflammatory demyelinating disease of the central nervous system (CNS). ADEM usually manifests after a viral infection or a vaccination and is most commonly seen in children. ADEM dominantly affects the white matter of the cerebral cortex, optic nerves, brain stem and spinal cord. This disease is immunologically mediated by an autoimmune phenomenon against the myelin sheath of neuronal cells. The pathological hallmark is perivenular inflammation with perivenous demyelination. Clinically, ADEM is characterized by acute encephalopathy, along with other multifocal CNS manifestations. Magnetic resonance imaging often reveals multifocal hyper-intense lesions, which predominate in the subcortical white matter of the brain. Infrequently, grey matter may also be affected. The majority of patients respond to intravenous methylprednisolone, with good neurological recovery. ADEM typically has a monophasic course. Multiphasic forms also have been reported. Multiphasic ADEM can be misdiagnosed as multiple sclerosis. The exact relationship between ADEM and multiple sclerosis needs further clarification.
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