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A 30 month old child with changed sensorium

Q1 (A): What does the MRI in figures 1 and 2 show?
The MRI scans of brain (fig 1 and 2) show high signal lesions of the same age on T2 weighted images in various parts of the subcortical white matter, midbrain, and cerebellum. Large confluent lesions are seen in the right subcortical region. These features are seen in acute disseminated encephalomyelitis (ADEM).

Q1 (B): What further tests would you perform on the CSF?
The additional test done on the CSF of this child was oligoclonal banding, which was positive. Oligoclonal bands of IgG, although more commonly seen in multiple sclerosis, can also be seen in ADEM as in the present case. Persistence of oligoclonal bands in serial CSF examinations suggests multiple sclerosis.¹

Q2: What is the treatment and prognosis for this condition?
The treatment of choice is high dose methyl prednisolone followed by a tapering dose of prednisolone over several weeks. This considerably decreases the rapid progression of symptoms and allows for a quicker and more complete recovery.² In severe cases, plasma exchange has been tried and there are . . . [Full text of this article]

Relevant Article

A 30 month old child with changed sensorium

S Ferns, S Adusumalli, J Gosalakkal, and A V Sridhar
Postgrad. Med. J. 2005 81: e8. [Extract] [Full Text] [PDF]