We describe two patients with fulminant acute disseminated encephalomy
elitis (ADEM) treated with plasmapheresis after they failed to improve
on steroids. Both patients improved concomitant with the plasma excha
nge. These are the first reported cases of fulminant ADEM with extensi
ve white matter abnormalities on imaging studies treated with a regime
n of plasmapheresis and steroids. Plasmapheresis may be beneficial in
this disorder.