Acute Disseminated Encephalomyelitis (ADEM)
A 6-year-old girl suffered from frequent blinking for 1 month. She visited a local ophthalmologist and was found to have optic atrophy in both eyes. She also complained of frequent headaches. Her best-corrected visual acuity was 5/60 in both eyes. Anterior segments were normal. Fundoscopic examination showed optic atrophy in both eyes (Fig. 20.1). A visual field examination revealed moderate obscuration in both eyes (Fig. 20.2). MR imaging showed multiple lesions in the subcortical white matter of the right frontal opercular region and temporoparietal, parietal, and posterior temporal regions, with the largest lesion about 4 cm in size localized at the right frontal opercular region. These lesions demonstrated low signal on T1WI, high signal on T2WI, and focal enhancement (Fig. 20.3). Acute disseminated encephalomyelitis (ADEM) with bilateral optic atrophy was suspected. Her vision recovered spontaneously to 6/10 in the right eye and CF in the left eye.