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Rare disease
Clinical improvement precedes lesion size regression in a severe case of acute disseminated encephalomyelitis
  1. Mark Stettner1,
  2. Philipp Albrecht1,
  3. Angelika Derksen1,
  4. Christian Hartmann1,
  5. Bernd Turowski2,
  6. Eva Neuen-Jacob3,
  7. Hans Peter Hartung1,
  8. Bernd C Kieseier1,
  9. Gabriele Arendt1
  1. 1Department of Neurology, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany
  2. 2Department of Diagnostic and Interventional Radiology, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany
  3. 3Department of Pathology, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany
  1. Correspondence to Dr Mark Stettner, mark.stettner{at}


Here, we present a case of a severe acute disseminated encephalomyelitis (ADEM) of a 42-year-old male patient. The diagnosis was established after brain biopsy and due to acutely evolving encephalopathy occurring in the context of atypical Mycoplasma pneumoniae (MP). We analysed the prominent MRI white matter lesions using a three-dimensional algorithm as cutting-edge technique to study morphological abnormalities and correlated them to the clinical condition of the patient. We found a discrepancy between the lesion size and the clinical deficits of the patient, actually the clinical improvement antedated the regression of the white matter lesions.

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