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World J Clin Cases. Sep 16, 2026; 14(26): 126833
Published online Sep 16, 2026. doi: 10.12998/wjcc.126833
Published online Sep 16, 2026. doi: 10.12998/wjcc.126833
Contrasting diagnostic challenges of headache before and after acute disseminated encephalomyelitis in children: Two case reports and review of literature
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Hospital, Arabian Gulf University, Manama 26671, Manama, Bahrain
Jameel Ahmed Nazeer, Department of Radiology, University Hospital, Arabian Gulf University, Manama 26671, Manama, Bahrain
Reem M Elbeltagi, Department of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Author contributions: Al-Beltagi M contributed to the conception and design of the report, clinical management and interpretation of the clinical findings; Nazeer JA and Elbeltagi RM contributed to the clinical data collection and radiological interpretation; Al-Beltagi M and Elbeltagi RM contributed to the laboratory interpretation and manuscript writing; Elbeltagi RM contributed to the manuscript review. All authors reviewed and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using Grammarly solely for language refinement, grammar correction, and improvement of readability. Google Gemini was used as an assistive tool to develop the visual timelines for cases 1 and 2. AI tools were not used to generate original clinical data, perform independent scientific analyses, interpret clinical findings, or draw scientific conclusions. All AI-assisted outputs were carefully reviewed, verified, and approved by the authors. The authors take full responsibility and accountability for the accuracy, integrity, originality, and scientific validity of the manuscript and all submitted materials.
Informed consent statement: Written informed consent was obtained from the parents/legal guardians of both patients for the publication of their clinical details and accompanying neuroimaging figures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Mohammed Al-Beltagi, MD, PhD, Professor, Consultant, Department of Pediatrics, Faculty of Medicine, Tanta University, Bld 1039, Road 2626, Block 226, Tanta 31511, Algharbia, Egypt. mbelrem@hotmail.com
Received: August 14, 2026
Revised: August 25, 2026
Accepted: September 16, 2026
Published online: September 16, 2026
Processing time: 35 Days and 15.1 Hours
Revised: August 25, 2026
Accepted: September 16, 2026
Published online: September 16, 2026
Processing time: 35 Days and 15.1 Hours
Core Tip
Core Tip: Headache may occur at different stages of pediatric acute disseminated encephalomyelitis (ADEM) and can create distinct diagnostic challenges. In the first case, severe headaches preceded the development of encephalopathy and multifocal neurological abnormalities. In the second, persistent headache continued after neurological recovery and prompted reassessment for ongoing inflammatory disease. Importantly, persistent headache alone does not establish recurrent or multiphasic ADEM. These cases emphasize the importance of interpreting headache based on its temporal relationship to neurological findings and using repeat neuroimaging and cerebrospinal fluid evaluation selectively when clinically indicated.