MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

“…Imaging abnormalities frequently resolve as the patient sustains clinical recovery [8,15,17,18]. Monophasic ADEM, at times, may be difficult to distinguish from the first attack of MS; however, MRI findings of diffuse, bilateral T2-hyperintense lesions in addition to absence of T1-hypointense Bblack holes^and lack of periventricular lesions weigh heavily in favor of a diagnosis of ADEM [23,24].…”

“…Female sex and an age of disease onset greater than 10 years old at initial ADS are associated with a higher likelihood of MS [6,25]. An abnormal brain MRI with clinically silent T2-hyperintense and T1-hypointense lesions at the time of first ADS along with the presence of intrathecal synthesis of oligoclonal bands are also associated with a high likelihood of MS [6,24]. The presence of encephalopathy or a normal brain MRI at the time of ADS (i.e., optic neuritis or transverse myelitis without demyelinating lesions within the brain parenchyma) portends a lower risk of MS [6,25,26].…”

Multiphasic ADEM reclassified in Multiple Sclerosis: a case with therapeutic implications

“…Some authors suggest the following features as an attempt to differentiate pediatric patients who will develop MS after a first episode of acute CNS demyelination: presence of T1 hypointense lesions and periventricular lesions on the initial brain MRI [3]; OCB presence on CSF, changes in the VEP and lack of involvement of thalamus or basal ganglia [4,5]. However, actually, there are no definite clinical or imaging criteria to allow predicting the evolution of these patients.…”

Treatment of CNS Vasculitis in Children

“…Lesions can affect all matters, may be unifocal or multifocal, symmetrical, or asymmetrical, and may enhance contrast. Atypical appearances including ring enhancement, mass lesions, and hemorrhages have been documented [40]. Focal or diffuse meningeal enhancement is characteristic for small vessel vasculitis, when untreated.…”