INDIAN PEDIATRICS 367 VOLUME 42 __ APRIL 17, 2005 BRIEF REPORTS Acute Disseminated Encephalomyelitis– A Case Series Sonia Madan, S. Aneja, R. P. Tripathi*, A.Batra*, Anju Seth and Veena Taluja From the Department of Pediatrics, Lady Hardinge Medical College; New Delhi and *Department of Radiology ; INMAS, Delhi, India. Correspondence to: Sonia Madan, B-3/ 17 A, Lawrence Road, Delhi 110 035. E-mail: Sachin@ndf.vsnl.net.in; Sachinmakhija25573@yahoo.com Manuscript received: November 11, 2003, Initial review completed: February 6, 2004; Revision accepted: October 25, 2004. Acute disseminated encephalomyelitis(ADEM) is an uncommon inflammatory demyelinating disease involving central nervous system white matter. A series of seven cases seen over a period of one year have been described. The patients presented with acute onset of focal neurological deficit (3 patients), alteration of sensorium(3) and ataxia(1). CT scan showed non specific hypodensity in 4 cases and was normal in 3 patients . MRI showed characteristic radiological changes. Complete recovery was seen in 3 patients , one died and 3 were left with sequelae. Key words: Acute disseminated encephalomyelitis, Methyl prednisolone, MRI. A DEM is a monophasic, polysymptomatic disorder involving central nervous system white matter. This immune mediated inflammatory process commonly follows viral infections, or may occur after vaccination. ADEM accounts for up to one third of all known cases of encephalitis. The polysymptomatic presentation reflects demyelinating lesions and consists of various combinations of motor, sensory, visual and cognitive symptoms. The clinicoradiological profile of 7 patients with acute disseminated encephalomyelitis is presented in this paper. Subjects and Methods The patients reported in this study were seen at Kalawati Saran Children’s Hospital, Delhi during the period of April 2000-March 2001. ADEM was suspected by development of acute neurological deficit occurring in close temporal relationship with a viral infection or vaccination and confirmed by typical radiological appearance on MRI. Cranial noncontrast and contrast enhanced CT was performed for all patients. MRI was performed for all patients with 1.5 T Magnetom vision of Siemens, Germany having a gradient strength of 25 MT / min. The non-contrast enhanced spin echo MRI was used to take axial, coronal, sagittal T1 weighted, T2 weighted spin echo images. In all planes slice thickness was 5 mm. Patients were followed up for a minimum of 6 months and follow up MRI was performed in 2 patients. Results The present study is a case series of seven patients diagnosed as ADEM by clinical presentation and radiological appearance and followed up for a minimum of 6 months. The cases have been summarized in Table I. The patients in our series, diagnosed as ADEM had very variable and polysymptomatic presentation. Three patients presented with focal presentation in the form of hemiparesis and focal seizures whereas there were cerebellar signs and generalized seizures in 1 patient. Three patients presented with altered sensorium. There was history of immunization in 2 patients (DPT/OPV in 1 and measles in other). CT Scan was normal or showed nonspecific hypo density. MRI clinched the diagnosis showing demyelination. This was