In evaluating ADEM, which of the following neuromotor findings aligns with the material?

• A. Asymmetry of extremities
• B. Uniform motor strength without asymmetry
• C. Hyperreflexia only in lower limbs
• D. No neurological deficits

Answer: (A)

In ADEM, lesions are patchy and affect CNS white matter in multiple locations, so neurologic signs appear in a focal and uneven way. This leads to asymmetric motor findings because different areas of the brain and spinal cord are involved to varying extents. Therefore, asymmetry of extremities best fits the typical neuromotor presentation of ADEM.

A uniform motor strength without asymmetry would suggest a more generalized or peripheral process rather than the patchy CNS involvement seen in ADEM. Hyperreflexia confined to only the lower limbs is unlikely, as central demyelination usually produces increased reflexes in multiple limbs rather than a one-limb pattern. No neurological deficits would be incompatible with ADEM, which presents with acute neurologic abnormalities.