1. Presentation Title Here (Example: Chronic ADEM) Name: _____________ Date: ______

2. History Age: _______ Sex: _______ Disease History – Example Previously healthy teenager Prone to migraines Please remember to de-identify your slides and remove identifying patient information.

3. Initial Presentation of Symptoms Example: – Admitted through the ER on 08/16 – Headache, fatigue, light headedness, confusion, visual difficulties, etc. Please remember to de-identify your slides and remove identifying patient information.

4. MRI of Initial Scan Please remember to de-identify your slides and remove identifying patient information.

5. Additional Tests/Results Examples: – CSF Test Results – NMO Testing – Any other relevant medical tests performed. Please remember to de-identify your slides and remove identifying patient information.

6. Continuing Symptoms Returning Date: _________ Example: – Pupillary findings no longer present. – MRI with ongoing inflammation in same distribution. – 1 week of fatigue, poor concentration, etc. Please remember to de-identify your slides and remove identifying patient information.

7. Other MRI Scans Please remember to de-identify your slides and remove identifying patient information.

8. Impressions/ Diagnosis and Treatment Example: – Prolonged ADEM? – MS? – NMO? – Other? Please remember to de-identify your slides and remove identifying patient information.