Irritability and lethargy are often early signs of acute disseminated encephalomyelitis (ADEM). Fever recurs in nearly half of all cases. Headache and meningism is detected commonly. Over period neurological abnormalities are seen. Among the most common abnormalities are the visual and language problems, the mental and psychological abnormalities. Disturbances in mental status, lethargy, fatigue, confusion, irritability and coma can occur in ADEM. Psychosis, personality changes, depression and irritability can occur. Focal or generalized convulsions are also not so uncommon.
Weakness is more than sensory defects. Long tract signs are present in majority of cases. Cranial nerve palsy is seen in cases of childhood ADEM. Sensory changes may be underestimated in young children. However, the posterior column deficits and hemisensory changes are less than in adult cases. Band dysesthesia or Lhermitte's sign is rare in ADEM.
Ataxia is present n about 35-60% of childhood ADEM, which differ from the case of ACA, as it is generally appendicular ataxia with nystagmus. Extrapyramidal disorders such as dystonia or choreoathetosis are sometimes observed.