Acute Disseminated Encephalomyelitis: A Gray Distinction.
Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, inflammatory acquired demyelinating syndrome predominantly affecting the white matter of the central nervous system.



We describe a three-year-old boy whose clinical presentation was suspicious for ADEM but whose initial imaging abnormalities were confined to the deep gray matter (without evidence of white matter involvement). His clinical course was fluctuating and repeat imaging one week after presentation demonstrated interval development of characteristic white matter lesions.



Treatment with adjunctive intravenous immunoglobulin and high-dose corticosteroids resulted in significant clinical improvement.



Isolated deep gray matter involvement can precede the appearance of white matter abnormalities of ADEM, suggesting that repeat imaging is indicated in individuals whose findings are clinically suspicious for ADEM but who lack characteristic imaging findings.
Division of Pediatric Neurology, Department of Neurology, University of Virginia, Charlottesville, Virginia.
Amal
A
Abu Libdeh
Division of Pediatric Neurology, Department of Neurology, University of Virginia, Charlottesville, Virginia.
Howard P
HP
Goodkin
Division of Pediatric Neurology, Department of Neurology, University of Virginia, Charlottesville, Virginia.
Denia
D
Ramirez-Montealegre
Division of Pediatric Neurology, Department of Neurology, University of Virginia, Charlottesville, Virginia. Electronic address: jnb8h@virginia.edu.
J Nicholas
JN
Brenton
D001921:Brain / Q000000981:diagnostic imaging* / Q000187:drug effects; D066193:Cervical Cord / Q000000981:diagnostic imaging* / Q000187:drug effects; D002675:Child, Preschool; D003937:Diagnosis, Differential; D018450:Disease Progression; D004673:Encephalomyelitis, Acute Disseminated / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D066128:Gray Matter / Q000000981:diagnostic imaging* / Q000187:drug effects; D006801:Humans; D008297:Male
ADEM; acute disseminated encephalomyelitis; autoimmune; encephalitis; gray matter