Brain MRI of a child 6 years of age with multiphasic acute disseminated encephalomyelitis (MADEM)

Brain MRI of a child age 6 years with multiphasic ADEM (MADEM). At presentation, T2-hyperintense lesions are demonstrated in the left ventrolateral putamen (A), mid-pontine dorsal tegmentum (facial colliculus), and left middle cerebellar peduncle (B). All lesions resolved on follow-up MR imaging (C) four months later. Two-and-a-half years later, another episode of ADEM was diagnosed clinically. MR imaging showed FLAIR-hyperintense lesions in subcortical white matter and body of corpus callosum (D), bilateral ventral midbrain tegmentum (E), dorsal upper pontine tegmentum and basis pontis (F), and upper ventral cervical cord (G). This case is atypical since in MADEM, a second episode of demyelination usually occurs within one year of the first.