What is the role of lab studies in the workup of acute disseminated encephalomyelitis (ADEM)?

Updated: Nov 08, 2018
  • Author: J Nicholas Brenton, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Platelet counts are elevated in a number of children with ADEM. Sedimentation rates are elevated in a third of patients. [47]

Modest-to-moderate elevation of CSF white and red blood cell counts may be found in childhood ADEM. Red blood cells may be due to modest degrees of AHLE. Elevated CSF HSV or Lyme titers do not exclude the possibility of associated ADEM, especially in recurrent herpes encephalitis. Results of CSF immune profile testing (eg, CSF:serum immunoglobulin G [IgG] index, CNS IgG synthetic rate, oligoclonality) employing age-appropriate normative data are positive in fewer than 10% of prepubertal children with ADEM. [10]

Positivity of studies for CSF oligoclonal bands and immunoglobulin elevation favors the diagnosis of MS in individuals younger than 20 years with first or recurrent bouts of acute CNS demyelinating illness. [7] In such instances it remains incumbent on those evaluating such individuals to exclude non-MS illnesses with specific biological markers such as systemic lupus, sarcoid, neuromyelitis optica, and so forth.

CSF myelin basic protein concentration level, reflecting demyelination, [83] is frequently elevated in ADEM.

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