Question
A 7-year-old boy develops acute onset fever, confusion, facial deviation, vomitings, and 3 episodes of seizures within 2 days.O/E the GCS was 8 ( E2V2M4), reflexes were brisk and there was bilateral papilloedema. A contrast-enhanced CT scan is attached. What is the most likely diagnosis:
| A. |
Acute viral encephalitis
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| B. |
Pseudotumor cerebri
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| C. |
Leukodystrophy
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| D. |
Acute demyelinating encephalomyelitis
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Show Answer
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Correct Answer � D
Explanation
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Ans. D, Acute demyelinating encephalomyelitis
ADEM presents as an acute onset multifocal encephalopathy with bilateral deep white matter irregular large lesions on neuroimaging. This child had multifocal involvement with signs of encephalopathy, raised ICT, and the typical radiological features. Anti-MOG ( myelin oligodendrocyte glycoprotein ) and anti aquaporin -4 antibodies can be positive in some cases. Treated with high dose intravenous steroids
Acute viral encephalitis and bacterial meningoencephalitis with virulent organisms can present this way with rapid progression, but neuroimaging is very typical of ADEM.
The history and clinical presentation make pseudotumor cerebri and leukodystrophy less likely.
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