An unusual case of adult-onset acute disseminated encephalomyelitis

Abstract

A 57 year old gentleman presented to our emergency department with a ten day history of progressive loss of balance, left-sided weakness and gait disturbance. CT brain showed bilateral subcortical hypodensities in the parietal lobes with right sided cortical involvement. Subsequent MRI of the neuro-axis showed symmetrical high FLAIR signal in the parietal lobes bilaterally, suggestive of Acute Disseminated EncephaloMyelitis (ADEM), while excluding cord lesions. CSF and serum analysis excluded alternative diagnoses. He was treated with high dose IV methylprednisolone followed by an oral steroid taper, with rapid clinical response aided by physical and occupational therapy.