Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of brain. It usually occurs following a viral infection but may appear following vaccination, bacterial or parasitic infection, or even appear spontaneously. It involves autoimmune demyelination.Full recovery is seen in 50 to 75% of cases, ranging to 70 to 90% recovery with some minor residual disability, with an average time to recover of one to six months.MRI is highly sensitive in detecting white matter lesions and the lesions described are rather extensive and subcortical in location. Involvement of the deep gray matter, particularly basal ganglia, is more frequent. Use of high-dose methylprednisolone, plasma exchange, and IVIG are based on the analogy of the pathogenesis of ADEM with that of multiple sclerosis (MS). Differentiation of ADEM from the first attack of MS is important from prognostic as well as therapeutic point of view. This differentiation is more relevant to India where the incidence of MS is low.
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