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From the Departments of Neurology (Drs. Hynson, Kornberg, Shield, and Harvey), and Radiology (Dr. Coleman and M. Kean), Royal Children’s Hospital; and Department of Paediatrics (Drs. Kornberg and Harvey), University of Melbourne, Parkville, Victoria, Australia.
Address correspondence to Dr. Andrew J. Kornberg, Department of Neurology, Royal Children’s Hospital, Flemington Road, Parkville, Victoria, Australia 3052; e-mail: kornberg{at}cryptic.rch.unimelb.edu.au
OBJECTIVE: To identify the clinical and neuroradiologic features of acute disseminated encephalomyelitis (ADEM) in childhood.
METHODS: A retrospective review was conducted of the medical records and MRI of children who presented to the Royal Children’s Hospital in Melbourne with ADEM between January 1993 and December 1998.
RESULTS: Of the 31 patients included in this study, 22 (71%) experienced a prodromal illness. Two patients (6%) had received hepatitis B vaccine 3 to 6 weeks before developing their illness. Symptoms and signs typically evolved over several days. Ataxia was the most common presenting feature, occurring in 20 patients (65%). MRI findings were variable, but lesions were most commonly seen bilaterally and asymmetrically in the frontal and parietal lobes. The authors found a high incidence of the corpus callosal and periventricular changes more typically associated with MS, but they also found a high rate of deep gray matter involvement (61% of patients). The use of high-dose IV methylprednisolone was usually associated with rapid recovery. Eighty-one percent of patients recovered completely, with only mild sequelae recorded in the remaining children.
CONCLUSION: In the absence of a biological marker, the distinction between ADEM and MS cannot be made with certainty at the time of first presentation, but the authors suggest that a viral prodrome, early-onset ataxia, high lesion load on MRI, involvement of the deep gray matter, and absence of oligoclonal bands are more indicative of ADEM.
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