Table 132.1.

Prominent clinical features of acute disseminated encephalomyelitis

Age at clinical onset	Prepubertal children (median 5–8 years of age)
Clinical presentation	Frequent precedent viral infection or immunization Acute onset (over days) Headache, fever Acute encephalopathy Polyfocal neurological deficits
CSF	Lymphocytic pleocytosis (variable) Mild to moderate increased protein Oligoclonal banding 0–29% (usually transient)
Brain MRI features	Should be abnormal in all cases Large, multifocal, ill-defined white matter lesions Deep gray matter frequently involved Absence of previous lesions
Spinal MRI features	Large, confluent lesions
Clinical course	Improvement; there may be residual deficits Monophasic course Occasionally recurrent and multiphasic variants may occur
MRI follow-up	Complete or partial lesion resolution No new lesions appear on follow-up