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Acute disseminated encephalomyelitis (ADEM) |
Features |
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Isolated postinfectious or post vaccinal attack on the CNS
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Diffuse demyelination, occasionally with fulminant hemorrhagic component (acute hemorrhagic encephalomyelitis or leukoencephalitis
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Symptoms |
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Encephalopathy: confusion, irritability, AMS (somnolence to coma)
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Multifocal deficits, fever, meningismus (headache, photophobia, stiff neck)
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Imaging |
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Large (greater than 1 to 2 cm) multifocal, hyperintense, bilateral, asymmetric lesions I the supra-/infratentorial white matter on T2-weighted or MRI FLAIR images
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Gray matter, especially basal ganglia and thalamus, may be involved
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Optic Neuritis (ON) |
Features |
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Usually a clinically isolated syndrome (CIS) caused by an inflammatory condition or idiopathic, but may be associated with MS or ADEM
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Symptoms |
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Headache and painful eye movements followed by vision loss, pupillary defect (Marcus Gunn pupil), or visual field defects
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Usually unilateral in adults but may be bilateral in children under 12
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Imaging |
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Gadolinium MRI shows acute demyelination confined to optic nerve
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Transverse Myelitis |
Features |
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Spinal cord dysfunction typically owing to inflammatory lesion
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Usually presents as a CIS, but may be associated with MS or ADEM
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Symptoms |
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Unilateral or bilateral motor or sensory deficits such as Paresthesias, weakness, sphincter dysfunction; can occasionally be more severe, including paraplegia and urinary retention
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Imaging |
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Gadolinium-enhancing lesions on MRI spreading over 1 or more segments
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Neuromyelitis Optica (NMO) |
Features |
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Dx requires ON, myelitis, and 2 out of the following 3: longitudinally extensive spinal cord lesion more than three segments in length, brain MRI non-diagnostic for MS, NMO-IgG seropositivity (Wingerchuk et al., 2007)
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More common in non-Caucasians, especially Asians
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Rule out sarcoid, SLE, Sjogrens or other vasculitis
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Symptoms |
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Combination of concurrent or sequential bilateral optic neuropathy and transverse myelitis
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