Acute disseminated encephalomyelitis

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Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of the brain.[1][2][3] It usually occurs following a viral infection but may appear following vaccination, bacterial or parasitic infection, or even appear spontaneously. As it involves autoimmune demyelination, it is similar to multiple sclerosis, and is considered part of the Multiple sclerosis borderline[4][5] diseases. The incidence rate is about 8 per 1,000,000 people per year.[6] Although it occurs in all ages, most reported cases are in children and adolescents, with the average age around 5 to 8 years old.[7][8][9] The mortality rate may be as high as 5%, full recovery is seen in 50 to 75% of cases, while up to 70 to 90% recover with some minor residual disability.[10] The average time to recover is one to six months.

ADEM produces multiple inflammatory lesions in the brain and spinal cord, particularly in the white matter. Usually these are found in the subcortical and central white matter and cortical gray-white junction of both cerebral hemispheres, cerebellum, brainstem, and spinal cord,[11] but periventricular white matter and gray matter of the cortex, thalami and basal ganglia may also be involved.

When the patient suffers more than one demyelinating episode, it is called Recurrent disseminated encephalomyelitis[12] or Multiphasic disseminated encephalomyelitis[13](MDEM).

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