Silent triggers and symmetric peduncles - a rare presentation of adult-onset acute disseminated encephalomyelitis: A case report

Table 1 Chronological timeline of clinical course and management

Day of illness	Event
0	Onset of high-grade fever and severe headache
2	Acute left facial paralysis
4	Progressive left hemiparesis (unable to walk/self-feed)
7	Focal seizure (right leg); hospital admission
8	Brain MRI + lumbar puncture performed
8-14	Persistent encephalopathy; fever resolution by Day 14
21	Spontaneous neurological improvement noted (strength/alertness)
22	High-dose IV methylprednisolone initiated (1 g/day)
22-26	IV methylprednisolone continued (5-day course)
27	Transition to oral prednisone taper (60 mg/day starting dose)
28	Transferred to rehabilitation ward; physiotherapy started
42	Motor strength 4/5; independent ambulation; discharged

MRI: Magnetic resonance imaging.