0:00

This is a child who presented with mental status

0:04

changes and seizures and was suspected

0:08

of having encephalomyelitis.

0:11

Here we have the axial FLAIR images,

0:13

the axial T2-weighted scan,

0:15

the postgadolinium-enhanced scan

0:17

through the axial plane.

0:20

This patient shows a wide variety

0:23

of abnormalities,

0:24

including involvement of the medulla,

0:28

involvement of the pons and

0:31

left side of the midbrain,

0:33

confluent areas in the temporal lobes,

0:36

as well as in the subinsular regions.

0:39

Large area of abnormality crossing

0:42

the corpus callosum,

0:45

as well as in the white matter

0:46

of the left corona radiata.

0:49

And then, there do appear to be

0:51

cortical lesions as well.

0:56

On this section on the right side,

1:00

one also can see areas of involvement of

1:04

the gray matter of the basal ganglia.

1:08

This is what I'm talking about,

1:09

these areas here,

1:10

which appear to be within

1:12

the putamen on the left side,

1:15

and the globus pallidus and

1:17

putamen on the right side.

1:19

So we have a process

1:21

which is multiple locations,

1:25

which include classic deep gray matter,

1:28

basal ganglia regions, as well as brain stem,

1:32

as well as the white matter in a child.

1:35

So looking back on the history,

1:38

this patient did have an antecedent

1:41

viral illness.

1:42

Now, this is a little bit cheat,

1:44

in that what child hasn't had a recent viral illness

1:50

in the elementary school years?

1:52

But nonetheless,

1:54

this patient's ultimate diagnosis was indeed

1:57

acute disseminated encephalomyelitis.

2:00

If we look at the post-gadolinium-enhanced scans,

2:04

you can see that just as with

2:05

multiple sclerosis,

2:07

there may be some enhancing and non-enhancing

2:11

lesions in the brain.

2:13

However,

2:14

I would venture to say that this pattern of

2:16

enhancement that we're seeing here will be very

2:20

atypical for multiple sclerosis.

2:22

Plus, the patient was younger than expected

2:25

for multiple sclerosis.

2:28

You can see an incidental arachnoid cyst.

2:32

And here, a more solidly enhancing

2:35

white matter lesion.

2:37

So in the child who has gray matter

2:40

and white matter lesions,

2:41

you may have a relatively fulminant monophasic

2:45

disorder of acute disseminated encephalomyelitis

2:48

that can affect many of the same locations

2:51

as multiple sclerosis.

2:53

But in addition,

2:54

the deep gray matter.