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Acquired Demyelinating disorders of the central nervous system in children span a wide spectrum. These conditions may be mono-phasic and self limiting or multi-phasic. Children may present with mono-focal (optic neuritis) or multi-focal (Acquired demyelinating encephalomyelitis) clinical findings. These demyelinating disorders also share many common clinical, radiological and laboratory features. Early classification of whether the disease is either monoor multiphasic has diagnostic and therapeutic implications. Identification of patients who present with a first demyelinating event and are at risk for evolution to multiple sclerosis, allows disease modifying therapeutic agents to be initiated early and thus preserve brain function. The aetiology of acquired demyelinating conditions is multi-factorial namely – genetic, postinfectious, post-immunization and possibly due to a T-cell mediated auto-immune response to myelin basic protein triggered by an infection or immunization. This chapter will cover the aetiologies, consensus definitions, clinical presentation, neuroimaging, evolution and therapeutic advances in acquired demyelinating disorders in children. The pivotal role of neuro-imaging in unraveling the pathology, aetiology and diagnosis of these disorders is also highlighted. Clinical and neuro-imaging features of other acquired white matter lesions (via infections, toxins, nutritional deficiencies, and osmotic myelinolysis) disease are also discussed.

Acquired Demyelinating Disorders of the CNS in Children