Article Text

Download PDFPDF
Acute disseminated encephalomyelitis or multiple sclerosis: can the initial presentation help in establishing a correct diagnosis?
  1. R C Dale,
  2. J A Branson
  1. Great Ormond Street Hospital NHS Trust and Institute of Child Health, London, UK
  1. Correspondence to:
    Dr R C Dale
    Neuroimmunology Laboratory, 9th Floor, Institute of Neurology, Queen Square, London WC1N 3BG, UK;


The differential diagnosis of CNS white matter disease is broad, and can be divided into vascular, metabolic, infective, or inflammatory aetiologies. Isolated inflammatory disorders of the CNS are often associated with demyelination, and the two terms (inflammatory and demyelinating) are often used in conjunction. When the disease is monophasic, the term acute disseminated encephalomyelitis (ADEM) is used.1 ADEM typically occurs as a post-infectious phenomenon, and by definition, must be an isolated (monophasic) episode. If a relapse occurs shortly after the ADEM presentation in association with a further infection or steroid withdrawal, the term MDEM (multiphasic disseminated encephalomyelitis) is used. When there are relapses or progressive disease, the term multiple sclerosis (MS) is used (for full recommended diagnostic criteria for multiple sclerosis refer to McDonald and colleagues2).

  • ADEM, acute disseminated encephalomyelitis
  • CNS, central nervous system
  • MDEM, multiphasic disseminated encephalomyelitis
  • MS, multiple sclerosis
  • ON, optic neuritis
  • ADEM
  • MS
  • multiple sclerosis
  • demyelination

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: none declared