1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Steven J Goldstein Affiliation: University of Kentucky

2. MedPix No: 13266 - History Pt Demographics: Age = 16 y.o. Gender = girl 16 year old girl with 1 week history of a *cold.* She was brought to the ER because she had become very lethargic and non-verbal. She had a questionable seizure as well. She has been complaining of weakness, cough, sore throat, and upper respiratory symptoms for approximately one week and became significantly altered today and has not been talking or responding to the patients mother and father. Downloaded by (-1)

3. MedPix No: 13266 - EXAM & LABS Lumbar Puncture: CSF was sent for analysis of cell count, gram stain culture, protein, and glucose, the results of which show an elevated number of nucleated cells showing 71% lymphocytes. The glucose was within normal range at 63 and the protein was elevated at 86. LDH and lactic acid werenormal and gram stain showed no organisms. No blood.

4. ADEM - Acute Disseminated Encephalomyelitis Negative CT scan Downloaded by (-1)

5. ADEM Negative CT scan Downloaded by (-1)

6. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

7. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

8. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

9. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

10. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

11. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

12. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

13. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

14. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

15. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

16. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

17. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

18. ADEM Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

19. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

20. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

21. ADEM - Acute Disseminated Encephalomyelitis Multiple lesions midbrain, pons and basal ganglia. - The lesions are high signal intensity of T2 and Flair imaging. - Lesions do not enhance. - Downloaded by (-1)

22. FINDINGS Multiple lesions in white matter, pons, midbrain, and basal ganglia. Lesion have elevated T2 signal with minimal mass effect. No enhancement

23. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Multiple Sclerosis - Lyme disease - Bechets disease - ADEM (acute disseminated encephalomyelitis)

24. Diagnosis: Acute Disseminated Encephalomyelitis Dx Confirmed by: Clinical presentation and MRI

25. DISCUSSION