Reporting Two Cases of Spinal ADEM and Short Review of Clinical and Radiological Evaluation of Acute Demyelination of Spinal Cord

Abstract Demyelinating disorders of spinal cord are not uncommon. There are many demyelinating conditions namely transverse myelitis (TM), neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), etc. Most conditions are post-infectious autoimmune demyelination; few have some genetic and environmental influences. Most of these conditions present as acute onset paraplegia along with other features of acute flaccid paraplegia (AFP). Therefore, AFP-related conditions should be excluded during clinical evaluation. Sensory features are helpful to differentiate these disorders. Bladder dysfunction in the form of initial retention followed by incontinence is found in most cases of cord demyelination. MRI of the spine is helpful in distinguishing these conditions. The long segment of the cord is involved in neuromyelitis optica and ADEM; whereas short segment involvement is found in TM and MS. Here, two cases of spinal ADEM are reported. Both cases presented with paraplegia and bladder dysfunction; an MRI spine showed long-segment spinal cord involvement. Both cases rapidly improved with pulse methylprednisolone. Therefore, during evaluation of acute paraplegia spinal ADEM should be kept in mind.