[Can acute disseminated encephalomyelitis progress in a deferred way?]

Area of Science:

• Neurology
• Pediatric Neurology
• Immunology

Background:

• Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disease.
• ADEM typically presents as a monophasic illness, but heterogeneous clinical courses are increasingly recognized.
• Differentiating recurrent ADEM from other demyelinating conditions like multiple sclerosis (MS) is crucial for appropriate management.

Observation:

• A 5-year-old boy experienced two distinct episodes of neurological symptoms separated by several weeks.
• Clinical presentation and magnetic resonance imaging (MRI) findings were consistent with ADEM.
• Cerebrospinal fluid (CSF) analysis showed no oligoclonal bands, aiding in the exclusion of multiple sclerosis (MS).

Findings:

• The recurrent neurological symptoms in this pediatric patient suggest a multiphasic disseminated encephalomyelitis (MDEM).
• The case demonstrates that ADEM can exhibit a multiphasic or relapsing-remitting course.
• Exclusion of MS was based on clinical course, MRI, and CSF findings.

Implications:

• Recognition of MDEM is important for accurate diagnosis and prognosis in pediatric demyelinating diseases.
• Prompt and aggressive treatment, including corticosteroids and immunoglobulins, may lead to favorable outcomes in MDEM.
• This case underscores the importance of considering multiphasic presentations of ADEM in children.