Kassif OB, et al. - In this retrospective review of children diagnosed with acute disseminated encephalomyelitis (ADEM), researchers investigated how the timing of magnetic resonance imaging (MRI) was effected by clinical findings in the initial emergency department (ED) presentation. They recorded clinical presentation at ED admission and compared patients who had an MRI as part of their ED evaluation (early MRI) vs those who had MRI performed during ward hospitalization (late MRI). They noted the absence of encephalopathy at ED presentation in 20% of ADEM patients. Earlier MRI utilization, and consequently earlier diagnosis and treatment, was reported in relation to polyfocal neurological signs and absence of fever at ED presentation. The ED clinician familiar with the ADEM pattern of signs and with a high level of suspicion may help with early diagnosis and treatment of this rare disease.