Which imaging pattern is typical of Acute Disseminated Encephalomyelitis (ADEM) as compared with pediatric multiple sclerosis?

Which imaging pattern is typical of Acute Disseminated Encephalomyelitis (ADEM) as compared with pediatric multiple sclerosis?

• A. MS presents with acute encephalopathy and diffuse edema-like lesions
• B. ADEM typically presents acutely with encephalopathy and multifocal edema-like lesions, often monophasic
• C. ADEM shows discrete, well-demarcated lesions with dissemination in time and space
• D. MS is always monophasic

Answer: (B)

The key idea is that ADEM in children usually presents with an acute onset of brain dysfunction (encephalopathy) and widespread, edema-like white-matter–signal changes on MRI that are multifocal and often look confluent. This pattern fits an acute inflammatory demyelinating process that is typically monophasic, meaning one episode with no ongoing/new demyelinating events after the initial event. So, describing ADEM as occurring acutely with encephalopathy and multifocal edema-like lesions, often in a monophasic course, matches what clinicians expect for imaging and clinical behavior in this condition. In contrast, pediatric MS tends to show discrete, well-defined lesions and requires evidence of dissemination in time and space, and MS is not limited to a single attack.

The key idea is that ADEM in children usually presents with an acute onset of brain dysfunction (encephalopathy) and widespread, edema-like white-matter–signal changes on MRI that are multifocal and often look confluent. This pattern fits an acute inflammatory demyelinating process that is typically monophasic, meaning one episode with no ongoing/new demyelinating events after the initial event.

So, describing ADEM as occurring acutely with encephalopathy and multifocal edema-like lesions, often in a monophasic course, matches what clinicians expect for imaging and clinical behavior in this condition. In contrast, pediatric MS tends to show discrete, well-defined lesions and requires evidence of dissemination in time and space, and MS is not limited to a single attack.