Multiple ring enhancement in a case of acute reversible demyelinating disease in childhood suggestive of acute multiple sclerosis

A 5-year-old Japanese boy was admitted to our hospital because of progressive visual disturbance and quadriplegia. Computed tomography (CT) revealed multiple low density areas in the cerebral white matter, and intravenous injection of contrast medium resulted in ring enhancement around these areas. Exploratory aspiration of one of the low density areas gave a xanthochromic, viscous fluid. Pathologic examination of the drained fluid demonstrated small pieces of brain tissue with necrotizing lesions surrounded by demyelinating areas. The patient has been followed up for 3 years with corticosteroid treatment, and marked improvement has been achieved both in neurological examination and CT findings. From these clinicopathological findings an acute form of multiple sclerosis (MS) in childhood was suspected.