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### Selected Images
![Axial FLAIR MR shows peripheral, confluent areas of hyperintensity predominantly involving the subcortical white matter (WM) in this child with ADEM. The bilateral but asymmetric pattern is typical of ADEM.](images/app.statdx.com_image_deba3310-8e09-466c-97d2-1e6bccb28edf_dafbadc1_20251018T064947Z.jpg)
*Axial FLAIR MR shows peripheral, confluent areas of hyperintensity predominantly involving the subcortical white matter (WM) in this child with ADEM. The bilateral but asymmetric pattern is typical of ADEM.*
![Axial FLAIR MR shows peripheral, confluent areas of hyperintensity predominantly involving the subcortical white matter (WM) in this child with ADEM. The bilateral but asymmetric pattern is typical of ADEM.](images/app.statdx.com_image_thumbnail_deba3310-8e09-466c-97d2-1e6bccb28edf_size_168_quality_85_3dfef960_20251018T064936Z.jpg)
*Axial FLAIR MR shows peripheral, confluent areas of hyperintensity predominantly involving the subcortical white matter (WM) in this child with ADEM. The bilateral but asymmetric pattern is typical of ADEM.*
![Axial T1 C+ MR in the same patient shows marked, irregular enhancement of nearly all lesions. As ADEM is a monophasic illness, enhancement of the majority of lesions is typical; all lesions have a similar time course. Enhancement of multiple sclerosis (MS) lesions is more variable.](images/app.statdx.com_image_e18458d3-5f6e-43fd-ab6d-72c7a86dca92_0f3893d6_20251018T064949Z.jpg)
*Axial T1 C+ MR in the same patient shows marked, irregular enhancement of nearly all lesions. As ADEM is a monophasic illness, enhancement of the majority of lesions is typical; all lesions have a similar time course. Enhancement of multiple sclerosis (MS) lesions is more variable.*
![Axial FLAIR MR shows peripheral, confluent areas of hyperintensity predominantly involving the subcortical white matter (WM) in this child with ADEM. The bilateral but asymmetric pattern is typical of ADEM.](images/app.statdx.com_image_thumbnail_deba3310-8e09-466c-97d2-1e6bccb28edf_size_174_quality_85_61e31a0b_20251018T152348Z.jpg)
*Axial FLAIR MR shows peripheral, confluent areas of hyperintensity predominantly involving the subcortical white matter (WM) in this child with ADEM. The bilateral but asymmetric pattern is typical of ADEM.*
![Axial T1 C+ MR in the same patient shows marked, irregular enhancement of nearly all lesions. As ADEM is a monophasic illness, enhancement of the majority of lesions is typical; all lesions have a similar time course. Enhancement of multiple sclerosis (MS) lesions is more variable.](images/app.statdx.com_image_thumbnail_e18458d3-5f6e-43fd-ab6d-72c7a86dca92_size_168_quality_85_70272c40_20251018T064936Z.jpg)
*Axial T1 C+ MR in the same patient shows marked, irregular enhancement of nearly all lesions. As ADEM is a monophasic illness, enhancement of the majority of lesions is typical; all lesions have a similar time course. Enhancement of multiple sclerosis (MS) lesions is more variable.*
![Axial T1 C+ MR shows an incomplete ring of peripheral enhancement, typical of a demyelinating process. Other contrast enhancement patterns include ovoid or punctate homogeneous enhancement.](images/app.statdx.com_image_53135c0f-4c9e-4fb9-ab09-df46c5b40f70_c986514a_20251018T064950Z.jpg)
*Axial T1 C+ MR shows an incomplete ring of peripheral enhancement, typical of a demyelinating process. Other contrast enhancement patterns include ovoid or punctate homogeneous enhancement.*
![Axial T1 C+ MR shows an incomplete ring of peripheral enhancement, typical of a demyelinating process. Other contrast enhancement patterns include ovoid or punctate homogeneous enhancement.](images/app.statdx.com_image_thumbnail_53135c0f-4c9e-4fb9-ab09-df46c5b40f70_size_168_quality_85_3f185a62_20251018T064936Z.jpg)
*Axial T1 C+ MR shows an incomplete ring of peripheral enhancement, typical of a demyelinating process. Other contrast enhancement patterns include ovoid or punctate homogeneous enhancement.*
![Axial DWI MR shows increased signal in areas of FLAIR hyperintensity. The foci were hypointense on ADC images, indicating diffusion restriction. Both WM and gray matter involvement is present. Diffusion restriction is an uncommon imaging finding and is associated with a worse prognosis.](images/app.statdx.com_image_b79995c4-6bff-49f1-af71-cb56fe4b4aa1_119a9c33_20251018T064951Z.jpg)
*Axial DWI MR shows increased signal in areas of FLAIR hyperintensity. The foci were hypointense on ADC images, indicating diffusion restriction. Both WM and gray matter involvement is present. Diffusion restriction is an uncommon imaging finding and is associated with a worse prognosis.*
![Axial DWI MR shows increased signal in areas of FLAIR hyperintensity. The foci were hypointense on ADC images, indicating diffusion restriction. Both WM and gray matter involvement is present. Diffusion restriction is an uncommon imaging finding and is associated with a worse prognosis.](images/app.statdx.com_image_thumbnail_b79995c4-6bff-49f1-af71-cb56fe4b4aa1_size_168_quality_85_03275787_20251018T064936Z.jpg)
*Axial DWI MR shows increased signal in areas of FLAIR hyperintensity. The foci were hypointense on ADC images, indicating diffusion restriction. Both WM and gray matter involvement is present. Diffusion restriction is an uncommon imaging finding and is associated with a worse prognosis.*
![Axial T2 MR shows hyperintense lesions in the brachium pontis bilaterally, typical for demyelination. The right-sided lesion shows a targetoid <img src='/img/arrows/WS.png'/> appearance. Enhancement of several lesions was present on postcontrast T1 images (not shown).](images/app.statdx.com_image_f74d958e-f845-47e7-884e-331bf3dcb299_89b1781b_20251018T064952Z.jpg)
*Axial T2 MR shows hyperintense lesions in the brachium pontis bilaterally, typical for demyelination. The right-sided lesion shows a targetoid <img src='/img/arrows/WS.png'/> appearance. Enhancement of several lesions was present on postcontrast T1 images (not shown).*
![Axial T2 MR shows hyperintense lesions in the brachium pontis bilaterally, typical for demyelination. The right-sided lesion shows a targetoid <img src='/img/arrows/WS.png'/> appearance. Enhancement of several lesions was present on postcontrast T1 images (not shown).](images/app.statdx.com_image_thumbnail_f74d958e-f845-47e7-884e-331bf3dcb299_size_168_quality_85_10b7c767_20251018T064936Z.jpg)
*Axial T2 MR shows hyperintense lesions in the brachium pontis bilaterally, typical for demyelination. The right-sided lesion shows a targetoid <img src='/img/arrows/WS.png'/> appearance. Enhancement of several lesions was present on postcontrast T1 images (not shown).*
![Axial FLAIR MR shows large, confluent regions of hyperintense signal <img src='/img/arrows/CC.png'/> in the periventricular and subcortical WM in a 14 year old who presented with neck stiffness, fatigue, and seizures.](images/app.statdx.com_image_3e8a9c1e-560e-4c5c-93bc-dda9b3773622_eda9eb67_20251018T064954Z.jpg)
*Axial FLAIR MR shows large, confluent regions of hyperintense signal <img src='/img/arrows/CC.png'/> in the periventricular and subcortical WM in a 14 year old who presented with neck stiffness, fatigue, and seizures.*
![Axial FLAIR MR shows large, confluent regions of hyperintense signal <img src='/img/arrows/CC.png'/> in the periventricular and subcortical WM in a 14 year old who presented with neck stiffness, fatigue, and seizures.](images/app.statdx.com_image_thumbnail_3e8a9c1e-560e-4c5c-93bc-dda9b3773622_size_168_quality_85_caf40da9_20251018T064936Z.jpg)
*Axial FLAIR MR shows large, confluent regions of hyperintense signal <img src='/img/arrows/CC.png'/> in the periventricular and subcortical WM in a 14 year old who presented with neck stiffness, fatigue, and seizures.*
![Axial SWI MR in the same patient shows petechial hemorrhages <img src='/img/arrows/CS.png'/> in regions of FLAIR signal abnormality.](images/app.statdx.com_image_fa96c2d2-8153-44c2-bd76-be0296382093_e2505a5f_20251018T064955Z.jpg)
*Axial SWI MR in the same patient shows petechial hemorrhages <img src='/img/arrows/CS.png'/> in regions of FLAIR signal abnormality.*
![Axial SWI MR in the same patient shows petechial hemorrhages <img src='/img/arrows/CS.png'/> in regions of FLAIR signal abnormality.](images/app.statdx.com_image_thumbnail_fa96c2d2-8153-44c2-bd76-be0296382093_size_168_quality_85_93dd4c72_20251018T064936Z.jpg)
*Axial SWI MR in the same patient shows petechial hemorrhages <img src='/img/arrows/CS.png'/> in regions of FLAIR signal abnormality.*
![Sagittal T1 C+ MR in the same patient shows extensive irregular ring enhancement <img src='/img/arrows/CC.png'/> in multiple subcortical WM lesions. Acute hemorrhagic leukoencephalopathy (AHL) is a rare manifestation of ADEM occurring in 2% of cases. AHL is associated with a very poor prognosis. Aggressive therapeutic management is a prerequisite to avoid usual disease course with fatal outcome.](images/app.statdx.com_image_b9452b6b-6772-4d91-8ca4-47ceaafa25f4_ddfedaec_20251018T064957Z.jpg)
*Sagittal T1 C+ MR in the same patient shows extensive irregular ring enhancement <img src='/img/arrows/CC.png'/> in multiple subcortical WM lesions. Acute hemorrhagic leukoencephalopathy (AHL) is a rare manifestation of ADEM occurring in 2% of cases. AHL is associated with a very poor prognosis. Aggressive therapeutic management is a prerequisite to avoid usual disease course with fatal outcome.*
![Sagittal T1 C+ MR in the same patient shows extensive irregular ring enhancement <img src='/img/arrows/CC.png'/> in multiple subcortical WM lesions. Acute hemorrhagic leukoencephalopathy (AHL) is a rare manifestation of ADEM occurring in 2% of cases. AHL is associated with a very poor prognosis. Aggressive therapeutic management is a prerequisite to avoid usual disease course with fatal outcome.](images/app.statdx.com_image_thumbnail_b9452b6b-6772-4d91-8ca4-47ceaafa25f4_size_168_quality_85_3dcd4458_20251018T064936Z.jpg)
*Sagittal T1 C+ MR in the same patient shows extensive irregular ring enhancement <img src='/img/arrows/CC.png'/> in multiple subcortical WM lesions. Acute hemorrhagic leukoencephalopathy (AHL) is a rare manifestation of ADEM occurring in 2% of cases. AHL is associated with a very poor prognosis. Aggressive therapeutic management is a prerequisite to avoid usual disease course with fatal outcome.*
![Coronal T2 MR shows large, confluent regions of hyperintense signal in the WM <img src='/img/arrows/WO.png'/> and deep gray nuclei <img src='/img/arrows/WS.png'/> of a child with ADEM. Although ADEM predominantly involves WM, gray matter is often affected.](images/app.statdx.com_image_113e918b-8d8f-46b8-8664-e0f617904251_b9bf7b86_20251018T064958Z.jpg)
*Coronal T2 MR shows large, confluent regions of hyperintense signal in the WM <img src='/img/arrows/WO.png'/> and deep gray nuclei <img src='/img/arrows/WS.png'/> of a child with ADEM. Although ADEM predominantly involves WM, gray matter is often affected.*
![Coronal T2 MR shows large, confluent regions of hyperintense signal in the WM <img src='/img/arrows/WO.png'/> and deep gray nuclei <img src='/img/arrows/WS.png'/> of a child with ADEM. Although ADEM predominantly involves WM, gray matter is often affected.](images/app.statdx.com_image_thumbnail_113e918b-8d8f-46b8-8664-e0f617904251_size_168_quality_85_1b06d2b7_20251018T064936Z.jpg)
*Coronal T2 MR shows large, confluent regions of hyperintense signal in the WM <img src='/img/arrows/WO.png'/> and deep gray nuclei <img src='/img/arrows/WS.png'/> of a child with ADEM. Although ADEM predominantly involves WM, gray matter is often affected.*
@@ -466,15 +442,9 @@ breadcrumbs:
### Additional Images
![Axial FLAIR MR shows multiple bilateral, asymmetric, flocculent, hyperintense lesions of acute disseminated encephalomyelitis.](images/app.statdx.com_image_bac2d338-fffe-48e4-be97-bb8258970076_425b9699_20251018T065002Z.jpg)
*Axial FLAIR MR shows multiple bilateral, asymmetric, flocculent, hyperintense lesions of acute disseminated encephalomyelitis.*
![Axial FLAIR MR shows multiple bilateral, asymmetric, flocculent, hyperintense lesions of acute disseminated encephalomyelitis.](images/app.statdx.com_image_thumbnail_bac2d338-fffe-48e4-be97-bb8258970076_size_168_quality_85_4b79e54c_20251018T064936Z.jpg)
*Axial FLAIR MR shows multiple bilateral, asymmetric, flocculent, hyperintense lesions of acute disseminated encephalomyelitis.*
![Coronal T1 C+ MR demonstrates partial peripheral enhancement around multiple asymmetric, flocculent lesions of acute disseminated encephalomyelitis. Note the supra- and infratentorial lesions.](images/app.statdx.com_image_674fcfe9-2db8-4d36-a55c-9ca0a0672252_4fcbd413_20251018T065003Z.jpg)
*Coronal T1 C+ MR demonstrates partial peripheral enhancement around multiple asymmetric, flocculent lesions of acute disseminated encephalomyelitis. Note the supra- and infratentorial lesions.*
![Coronal T1 C+ MR demonstrates partial peripheral enhancement around multiple asymmetric, flocculent lesions of acute disseminated encephalomyelitis. Note the supra- and infratentorial lesions.](images/app.statdx.com_image_thumbnail_674fcfe9-2db8-4d36-a55c-9ca0a0672252_size_168_quality_85_05b2865d_20251018T064936Z.jpg)
*Coronal T1 C+ MR demonstrates partial peripheral enhancement around multiple asymmetric, flocculent lesions of acute disseminated encephalomyelitis. Note the supra- and infratentorial lesions.*