Acute demyelinating encephalomyelitis
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Synopsis

The most common triggers, when identified, are viral or bacterial infections including rubeola, rubella, mumps, varicella, Epstein-Barr virus, human herpesvirus 6, influenza, HIV, and Mycoplasma pneumoniae. There have been reports of ADEM following Zika virus infection. Prognosis is variable and outcomes are more favorable in children. Most patients will improve but over 50% will have residual deficits. It is typically a monophasic illness, although relapses can occur.
Acute hemorrhagic encephalomyelitis is a hemorrhagic variant of ADEM with a more rapid onset and progression of neurologic symptoms. It is associated with hemorrhagic demyelinating lesions and carries a worse prognosis.
Codes
ICD10CM:G04.00 – Acute disseminated encephalitis and encephalomyelitis, unspecified
SNOMEDCT:
83942000 – Acute disseminated encephalomyelitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Multiple sclerosis
- Central nervous system vasculitis (see cerebral vasculitis)
- Central nervous system metastases
- Sarcoidosis
- Paraneoplastic encephalomyelopathy
- Central pontine myelinolysis
- Post-radiation myelinolysis
- Behçet disease
- Progressive multifocal leukoencephalopathy
- Septic emboli
- Cyclosporine toxicity
- Tacrolimus toxicity
- Posterior reversible encephalopathy syndrome
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References
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Last Reviewed:02/11/2019
Last Updated:03/03/2019
Last Updated:03/03/2019