Clinical Presentation

A 7-year-old with inability to walk after a recent viral illness.

Further Work-up

(A,B) Axial fluid-attenuated inversion recovery (FLAIR) magnetic resonance images (MRIs): there are bilaterally asymmetric, patchy, high-signal areas in the gray matter and subcortical white matter (arrows). (C) Sagittal T2 image of the thoracic spine: there are abnormal areas of increased signal in the central portion of the cord (arrow).

Differential Diagnosis

• Acute disseminated encephalomyelitis (ADEM): These lesions are characteristic of ADEM.