Note that the lesions above do not enhance with contrast.

ADEM (acute disseminated encephalomyelitis): an inflammatory, demyelinating disorder, primarily of children, typically occurs after an infection (often a URI) or vaccination. It often presents as encephalopathy and multifocal neurologic deficits. An LP may show a mild leukocytosis and elevated protein (as in this case), but may be normal. MRI is key to the diagnosis and shows subcortical white matter hyperintensity on T2, with basal ganglia, brainstem, and spinal cord also commonly affected. Enhancement is unusual and suggestive of infection. Accepted treatment is with high dose steroids, followed by an oral taper. Other experimental immunosuppresive therapies have been tried. Prognosis is generally good, with 60-90% having a complete recovery. Traditionally considered monophasic in nature, multiple episodes are often reclassified as multiple sclerosis.

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