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A 22 year-old woman presented with the acute onset of rapidly progressive quadriplegia and confusion.
Axial MRI Flair images. Note the lesions in the pons (left image) and scattered through the white matter in the occipital lobes bilaterally (right image). Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating syndrome that occurs in association with an immunization or viral infection. It is characterized clinically by rapid development of focal or multifocal neurological dysfunction. Clinical features include encephalopathy ranging from lethargy to coma, seizures, and focal and multifocal signs reflecting cerebral (hemiparesis), brainstem (cranial nerve palsies), and spinal cord (paraparesis) involvement. In some cases, it may not be possible to distinguish ADEM from the first episode of multiple sclerosis (MS). The mortality varies between 10% and 30%, with complete recovery in 50%.
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