Acute disseminated encephalomyelitis (ADEM) is a rare disease of central nervous system with a spectrum of presentation. It is a diagnosis of exclusion and relies on neuroimaging which may be normal at the onset. It is a diagnostic challenge at its first attack. The disease is although more common in children it can invariably be present in adults. Here we present a case report of ADEM in a 30 year old female who presented to ER with history of multiple episodes of vomiting followed by sudden onset of dysphasia and other neurological complaints. The patient had a history of recent travel to a pilgrimage where she had enteric fever around 15 days ago. It was our neurology team which correctly recognised and treated it as ADEM. The patient responded well to the treatment and discharged in stable condition after 5days. Sadly the disease had a relapse which now showed no response to iv immunoglobulins, steroids or plasmapheresis. The patient was in the hospital for symptomatic management and is still surviving in the hope of a normal well being.

Keywords: Acute Disseminated Encephalomyelitis; Central Nervous System; Neuroimaging.