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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Inflammatory Demyelination | 9H Case 9 Outcome
This patient is alive 4 years later with serious sequela but thought still consistent with atypical ADEM. Since 10/2014, dramatic interval progression of multifocal cortical and subcortical FLAIR abnormality and confluent FLAIR abnormality involving essentially all other white matter regions within the brain as well as the middle cerebellar peduncles, with perhaps mild sparing of the occipital poles. There is concomitant extensive white matter cavitation, most pronounced within the internal and external capsules and corpus callosum, with corresponding elevation of lactate peak within all measured spectra in these regions. Notably, there are petechial microhemorrhages within the areas of FLAIR abnormality, particularly within the posterior fossa.
This case shows a surprising degree of axonopathy arising from a typical inflammatory demyelination and may simply reflect a more fulminant process.
