[Acute disseminated encephalomyelitis (ADEM)]

Abstract

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