A 20-year-old right-handed man awoke with a severe headache and confusion and rapidly developed blurred vision, slurred speech, and right-sided hemiparesis. Initial MRI demonstrated a large demyelinating lesion involving white matter of the left parieto-occipital region with normal cortex and spinal cord. After stereotactic brain biopsy yielded a nondiagnostic specimen, FDG PET scan was performed and showed marked hypometabolism of the left parieto-occipital lobe with diaschisis of the contralateral cerebellum. Acute disseminated encephalomyelitis (ADME) was confirmed by means of a lumbar puncture showing elevated myelin basic protein in the cerebrospinal fluid. A follow-up MRI showed no new white matter lesions after 6 months, and he responded to steroid treatment. The patient recovered completely.
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