Magnetic resonance imaging and H magnetic resonance spectroscopy were used to detect possible structural and neurochemical abnormalities in two children, ages 6-months and 4.5 years, with acute disseminated encephalomyelitis at the State University of New York, Stony Brook, New York. The infant presented with focal seizures and thalamic and cerebral white matter lesions, and the older child with tremor and dystonia with bilateral basal ganglia lesions. Both recovered without the use of steroids or IV immunoglobulin. H MRS of involved areas showed abnormalities in N-acetyl-aspartate, choline, and lactate peaks during the symptomatic phase, and a low N-acetyl-aspartate persisted during recovery. The MRS findings are consistent with neuronal dysfunction, cellular membrane turnover, cellular infiltation, and metabolic stress in the acute phase, and with neuronal loss in the chronic phase. 
COMMENT. Metabolic studies using magnetic resonance spectroscopy should aid in diagnosis of ADEM and may prove of value in following the course of the disease and the need for therapy.