Contrasting diagnostic challenges of headache before and after acute disseminated encephalomyelitis in children: Two case reports and review of literature

Table 2 Key laboratory and diagnostic investigations

Investigation (collection time point)	Reference range	Case 1 (day +3)	Case 2 (initial acute presentation)/case 2 (3-month readmission)
CSF opening pressure	60-200 mm H2O	Normal (140 mm H2O)	Initial: Normal (130 mm H2O)/3-month: Normal (125 mm H2O)
CSF cells	0-5 lymphocytes/μL	50/μL (lymphocytic predominance)	Initial: 2 lymphocytes/μL/3-month: 1 lymphocyte/μL
CSF protein	15-45 mg/dL	Elevated (75 mg/dL)	Initial: Normal (41 mg/dL)/3-month: Normal (38 mg/dL)
CSF glucose	50-80 mg/dL (or ≥ 60% of serum)	Normal (55 mg/dL)	Initial: Normal (63 mg/dL)/3-month: Normal (60 mg/dL)
Serum glucose	70-110 mg/dL	89 mg/dL	92 mg/dL
OCB	Negative	Negative (CSF and serum)	Not detected
Serum MOG-IgG (pre-treatment)	Negative (< 1:16 titer)	Negative (by live cell-based assay)	Negative (by live cell-based assay)
Serum AQP4-IgG (pre-treatment)	Negative (< 1:16 titer)	Negative (by live cell-based assay)	Negative (by live cell-based assay)
MRI brain	Normal	ADEM pattern (multifocal white matter lesions, no restricted diffusion, no contrast enhancement)	ADEM pattern (bilateral confluent white matter lesions, no restricted diffusion, no contrast enhancement)
MRI spine	Normal	Normal	Normal
EEG	Normal organization	Diffuse and focal background slowing	Not tested

CSF: Cerebrospinal fluid; OCB: Oligoclonal bands; MOG-IgG: Myelin oligodendrocyte glycoprotein immunoglobulin G; AQP4-IgG: Aquaporin-4 immunoglobulin G; MRI: Magnetic resonance imaging; ADEM: Acute disseminated encephalomyelitis; EEG: Electroencephalography.