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Updated: Oct 5, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Sequential MR studies of a patient with white matter disease presenting psychotic symptoms: ADEM versus
W C Lin1, J F Lirng, F C Chang
1Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, Taiwan. wc_lin@vghtpe.gov.tw
Abstract:
Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both demyelinating white matter disorders. It is difficult to differentiate ADEM from single episode MS because of the similar clinical presentation, cerebral spinal fluid (CSF) analysis, histological finding and magnetic resonance image (MRI) appearance. We report an ADEM case with unusual clinical presentations of predominant psychiatric symptoms, and relatively long disease course. Initially, we were not able to distinguish it from single episode MS. By means of sequential MR images followed up 2 years and spectroscopy studies, and the dramatic clinical improvement after corticosteroid therapy, ADEM was diagnosed as the disease entity of this patient. In this case report we will present the MR findings of this patient and discuss the differentiation between the ADEM and MS.
Insights
Acute disseminated encephalomyelitis (ADEM) can mimic multiple sclerosis (MS) due to similar presentations. This case highlights how sequential MR imaging and response to corticosteroids aided in diagnosing ADEM with unusual psychiatric symptoms.
Area of Science:
- Neuroimmunology
- Neurology
Background:
- Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are challenging to differentiate due to overlapping clinical, CSF, histological, and MRI findings.
- Distinguishing between ADEM and a single episode of MS is often difficult.
Observation:
- A case of ADEM presented with atypical predominant psychiatric symptoms and a prolonged disease course.
- Initial presentation made differentiation from single episode MS impossible.
Findings:
- Sequential magnetic resonance imaging (MRI) over two years and spectroscopy studies were crucial for diagnosis.
- Dramatic clinical improvement following corticosteroid therapy strongly suggested ADEM.
Implications:
- This case underscores the importance of advanced imaging techniques and therapeutic response in diagnosing ADEM.
- Understanding these diagnostic nuances is vital for appropriate patient management and treatment strategies in demyelinating disorders.
