Disclosures: Renee Rosati, DO: Nothing to disclose

Case Description: The patient presented with rapidly progressive right-sided weakness and aphasia initially concerning for TIA/stroke. CT head showed L frontal lobe hypodensity sparing cortex. On day 2, he developed severe R-sided hemiplegia. Repeat CT head showed extension of frontal hypodensity still sparing cortex and normal spine CT. MRI was unattainable due to his BMI of 57. On day 4 he had acute onset angioedema requiring intubation. He continued steroids and empiric antibiotics without significant change in exam. LP revealed mild elevation in protein and IgG. On day 11, patient’s exam spontaneously began to improve with patient becoming more alert, overcoming L gaze preference, developing purposeful LUE movements, following limited central and LUE commands. Open MRI 3 weeks after admission revealed an inflammatory process suggestive of underlying GBM vs lymphoma vs fulminant inflammatory process. Neurosurgery performed a brain biopsy 4 weeks post admission and pathology was indicative of inflammatory process without evidence of malignancy. He was discharged to inpatient rehabilitation on Cellcept where he regained the ability to verbalize simple phrases over the course of several months.

Setting: Quaternary care hospital

Patient: A 40-year-old male with PMH of intermittent idiopathic angioedema, super morbid obesity, and HTN.

Assessment/Results: Anti-MOG serum antibody was sent to Mayo Clinic and a month later was positive. Patient was diagnosed with acute disseminated encephalomyelitis (ADEM).

Discussion: Histopathological descriptions of CNS lesions from patients with serum MOG ab are rare. A literature search identified a total of seven brain biopsies from six patients who had histological and immunohistochemical work up. This is the eighth reported case with a brain biopsy. His history of idiopathic angioedema may indicate and underlying predisposition to autoimmune disease.

Conclusion: Providers should add ADEM to their differential diagnosis alongside meningitis, multiple sclerosis, or CVA in a patient presenting with weakness, hemiplegia, aphasia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/adematous-an-unusual-case-of-a-40-year-old-man-with-adem-masquerading-as-a-stroke-a-case-report/