Editing Acute disseminated encephalomyelitis (section)

==Signs and symptoms==
ADEM has an abrupt onset and a monophasic course. Symptoms usually begin 1–3 weeks after infection. Major symptoms include [[fever]], [[headache]], [[nausea]] and [[vomiting]], [[confusion]], [[Blindness|vision impairment]], drowsiness, [[non-epileptic seizure|seizure]]s and [[coma]]. Although initially the symptoms are usually mild, they worsen rapidly over the course of hours to days, with the average time to maximum severity being about four and a half days.<ref name="Tenembaum_2002" /> Additional symptoms include [[hemiparesis]], [[paraparesis]], and [[cranial nerve palsies]].<ref>{{cite journal |vauthors = Allmendinger A, Krauthamer A, Spektor V | year = 2009 | title = Acute Disseminated Encephalomyelitis | series = Case of the month | url = http://www.diagnosticimaging.com/case-studies/content/article/113619/1493546 | archive-url = https://web.archive.org/web/20110224145009/http://www.diagnosticimaging.com/case-studies/content/article/113619/1493546 | archive-date = 24 February 2011 | journal = Diagnostic Imaging | volume = 31 | issue = 12| page = 10 }}</ref>

=== ADEM in COVID-19 ===
Neurological symptoms were the main presentation of COVID-19, which did not correlate with the severity of respiratory symptoms. The high incidence of ADEM with hemorrhage is striking. Brain inflammation is likely caused by an immune response to the disease rather than [[neurotropism]]. Cerebrospinal fluid analysis was not indicative of an infectious process, neurological impairment was not present in the acute phase of the infection, and neuroimaging findings were not typical of classical toxic and metabolic disorders. The finding of bilateral periventricular relatively asymmetrical lesions allied with deep white matter involvement, that may also be present in cortical gray-white matter junction, thalami, basal ganglia, cerebellum, and brainstem suggests an acute demyelination process.<ref name="Manikanta_2021">{{Cite journal | vauthors = Manikanta AK, Pradeep GV, Pydi R, Chanumolu AR, Joy LA, Kancherla N |date=2021-06-14|title=Acute Disseminated Encephalomyelitis in COVID 19- Systematic Review|url=https://www.annalsofrscb.ro/index.php/journal/article/view/7656|journal=Annals of the Romanian Society for Cell Biology|language=en|volume=25|issue=6|pages=11443–50}}</ref> Additionally, hemorrhagic white matter lesions, clusters of macrophages related to axonal injury and ADEM-like appearance were also found in subcortical white matter.<ref>{{cite journal | vauthors = Novi G, Rossi T, Pedemonte E, Saitta L, Rolla C, Roccatagliata L, Inglese M, Farinini D | display-authors = 6 | title = Acute disseminated encephalomyelitis after SARS-CoV-2 infection | journal = Neurology | volume = 7 | issue = 5 | date = September 2020 | pages = e797 | pmid = 32482781 | pmc = 7286650 | doi = 10.1212/NXI.0000000000000797 }}</ref>