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Acute disseminated encephalomyelitis (ADEM) is a multifocal inflammatory demyelinating disease of the CNS with monophasic presentation, which often follows a recent illness or vaccination.1 In our review of the ADEM literature, white matter lesions are always evident on MRI scans. We report nearly complete recovery in a patient who developed coma due to severe ADEM, but in whom MRI abnormalities were not evident until several days after presentation.
In May 1998, a 42-year-old woman experienced 6 days of cough, rhinorrhea, and diarrhea that were treated with cephalexin. On admission to another hospital, she had headache, stiff neck, fever (to 102 °F), intermittent confusion, and was unable to walk. Brain CT was normal. Lumbar puncture revealed 620 white cells/mm3 (84% neutrophils, 11% lymphocytes, 5% monocytes), 40 red cells/mm3, protein of 193 mg/dL, and glucose of 70 mg/dL. Gram stain was unrevealing. Ampicillin and ceftriaxone were started for presumed meningitis.
Her medical history was unremarkable. There was no history of exposure to ticks, pets, travel outside …
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