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Atypical Pediatric Demyelinating Diseases of the Central Nervous System

  • Demyelinating Disorders (J. Bernard & M. Cameron, Section Editors)
  • Published:
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Abstract

Purpose of Review

Pediatric central nervous system demyelinating diseases include multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). As diagnostic criteria become more inclusive, the risk of misdiagnosis of atypical demyelinating diseases of rheumatologic, infectious, and autoimmune etiology increases.

Recent Findings

We review mimics of multiple sclerosis, neuromyelitis optica spectrum disorder, and acute disseminated encephalomyelitis, including rheumatologic diseases: systemic lupus erythematosus and neuro-Behçet disease; infectious diseases: human immunodeficiency virus, progressive multifocal leukoencephalopathy, and subacute sclerosis panencephalitis; and autoimmune diseases including X-linked Charcot-Marie-Tooth disease, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) and autoimmune glial fibrillary acidic protein (GFAP) encephalopathy.

Summary

Atypical demyelinating disease may mimic classic neuroinflammatory diseases of the central nervous system. Imaging may meet criteria for a diagnosis of multiple sclerosis, or patients may present with optic neuritis and transverse myelitis consistent with neuromyelitis optica spectrum or myelin oligodendrocyte glycoprotein (MOG) antibody disorders. Through careful history-taking and review of atypical MRI findings, we may avoid misdiagnosis and mistreatment.

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Correspondence to Alison Christy.

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Regina M. Troxell and Alison Christy each declare no potential conflicts of interest.

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Troxell, R.M., Christy, A. Atypical Pediatric Demyelinating Diseases of the Central Nervous System. Curr Neurol Neurosci Rep 19, 95 (2019). https://doi.org/10.1007/s11910-019-1015-y

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