Acute disseminated encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) is an unusual demyelinating dis ease of the CNS. We review clinical symptoms, findings from radiological an d CSF examinations, and current treatment strategies for ADEM. This disorde r is often associated with a precedent infection or vaccination but may als o occur spontaneously. The clinical symptoms are highly variable. Analysis of CSF usually reveals lymphocytic pleocytosis and an elevated protein cont ent but may also yield normal results. Magnetic resonance imaging shows sol itary or multiple lesions within the CNS. Most patients improve quickly wit h methylprednisolone. If that fails, immunoglobulin, plasmapheresis, or cyt ostatic drugs can be employed. Unlike MS, ADEM has a monophasic course and favourable long-term prognosis. Multiphasic courses are very rare. There ar e no diagnostic criteria to distinguish ADEM reliably from MS during the ac ute phase. We presume that ADEM is a variant of MS and not an independent d isease entity.