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The paper describes the case of a 4-year-old girl who presented with an episode of ADEM and, 8 years later, multiple relapses associated with optic neuritis. The patient resulted positive to anti-MOG antibodies. About a third of patients with an ADEM event may present: a) a second demyelinating event, which, depending on the clinical characteristics, may lead to the definition of multiphasic ADEM (in which the relapse occurs at least one month after the acute phase); b) ADEM-ON (ADEM-Optic Neuritis), in which after the first episode the demyelinating relapses interest the optic nerve or Multiple Sclerosis (MS). MOG antibody-associated disorders (MOGADs) define a sub-group of CNS inflammatory-acquired demyelinating syndromes distinct from MS, and aquaporin-4 (AQP4) positive neuromyelitis optica spectrum disorder (NMOSD), typically including CNS clinical syndromes such as ADEM, optic neuritis, transverse myelitis, and AQP4-seronegative NMOSD. The first-line of treatment commonly recognized in the acute phase is IV corticosteroids in high-dose or IV immunoglobulins. In case of relapse, the drug with evidence of efficacy is rituximab; other choices are immunosuppressive therapies, in particular azathioprine and mycophenolate. Eculizaumb is specifically indicated in forms of optic neuromyelitis in patients with ab anti-AQP4 positivity.

The paper descibes the cases of a 10-year-old girl and a 3-year-old boy with CNS neoplasia. The girl presented with acute vomiting and cervicalgia while in the boy vomiting persisted for three months as the only symptom and was iniatially misinterpreted as due to gastroesophageal reflux. The authors stress that in very young children (< 4 y) persistent vomiting may be the only symptom of a CNS neoplasia.