Table 2

Comparative features of ADEM and multiple sclerosis (MS)

More likely in ADEMMore likely in MS
CSF, cerebrospinal fluid; MRI, magnetic resonance imaging.
▸ AgeChildrenAdults
▸ SexSlight male preponderance in children reversed in adultsApproximately twice as common in women
▸ SymptomsAntecedent infectionUsually less severe
Antecedent immunisationUnilateral optic neuritis
Usually more severeSlowly progressive symptoms
Brainstem symptoms
Multifocal neurological deficit
Bilateral optic neuritis
▸ CSFPleocytosisOligoclonal bands
Raised albumin fraction
Raised protein
▸ MRILarger lesionsPeriventricular lesions
Mass effect and oedemaHeterogeneous gadolinium enhancement
Grey matter involvementT1 hypointensities (“black holes”)
Uniform gadolinium enhancementNew lesions on follow up scan
Normal or resolving follow up scan (no new lesions)