Acute disseminated encephalomyelitis (ADEM)
Clinical history
This 8-year-old boy was admitted via the emergency room with several weeks of abdominal pain, vomiting, and constipation.
Physical examination revealed:
- dehydration,
- diffuse abdominal tenderness,
- bladder distension.
Neurological examination was normal, apart from slight nuchal rigidity. Subsequently, generalized dysesthesias developed, followed within a few days by paraplegia, with hypoesthesia to the T9 level.
Initial MRI (July 1991)
Image 1: Sagittal T1WI. Irregular multisegmental enlargement of the spinal cord, sparing the cervico-thoracic junction, with diffusely heterogenous signal characteristics.
Image 2: Sagittal Gd T1WI. Multiple inhomogeneously enhancing foci (see image 3), sparing only the C6-T1 segment, which remains normal in size.
Image 4: Axial Gd T1WI. Enlargement of the spinal cord with an ill-defined area of contrast enhancement in the left half of the cord, mainly located in the white matter.
Image 5: Sagittal T1WI of the brain. Small hypointense lesion in the posterior thalamic region, better seen on image 6.
Image 6: Axial PD and T2WI of the brain. The posterior thalamic lesion is seen as a high signal intensity lesion (see image 7) A second lesion is visible in the right subcortical parietal white matter (see image 8).
These cerebral lesions did not enhance after Gd injection.
Follow-up MRI (15 days later)
Image 9: Sagittal T1WI.
Image 10: Sagittal PD image.
Images 11 - 13: Sagittal T2WI.
Image 14: Sagittal Gd T1WI.
Image 15: Axial PD and T2WI of the brain.
Regression of the multiple spinal cord and cerebral lesions, although still faintly visible.
Second follow-up MRI (1 month later)
Images 16 - 17: Sagittal Gd T1WI. The spinal cord and brain now appear essentially normal.
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