Dr. Nene Devavrat Harihar
Neurology
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Patient's Query
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 on 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 an magnetic resonance imaging (MRI) and found some small grayish matter on 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 autoimmune? Also, can we rule out multiple sclerosis because the lumbar tap result was alright?
Hello,
Welcome to icliniq.com. 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.
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Neurology
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