Can eye floaters in children be a sign of ADEM?

Question

Hello doctor,

My 14-year-old daughter saw a little dot in her left eye (it could be a floater only) about a month ago. She is fine. There is no fever, no headache, no nausea, or pain in any part of her body.

When an ophthalmologist examined her, he told us that her optic nerve was elevated. So, he referred us to a neuro pediatrician. The neurologist then requested a magnetic resonance imaging (MRI) and found some small grayish matter in the brain, and declared that my daughter had acute disseminated encephalomyelitis (ADEM).

While on steroids, the neurologist requested a lumbar tap. The result was good. My question is: If there is a grayish matter on the brain (MRI), does this always mean ADEM or an autoimmune condition?

Also, can we rule out multiple sclerosis because the lumbar tap result was alright?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand the concern.

The differentials can be MS (multiple sclerosis), ADEM (acute disseminated encephalomyelitis), or other autoimmune disorders. ADEM should be suspected in a child who develops multifocal neurologic abnormalities with encephalopathy-like confusion, excessive irritability, or an altered level of consciousness following a viral infection or fever.

We can differentiate the two based on magnetic resonance imaging (MRI) findings. In the cerebrospinal fluid, greater than or equal to 50 white blood cells can be observed in ADEM, whereas this finding is highly atypical for multiple sclerosis.

I hope I have made it clear to you.

Take care.