Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder usually encountered in children or adolescents and characterized by multifocal neurological deficits of rapid onset. Typical target areas of demyelination include the corona radiata, centrum semiovale, periventricular white matter, cerebellar peduncles and brainstem. Involvement of deep gray matter nuclei is also frequent. We report a 6-year-old boy with ADEM who had only brainstem involvement. Serial magnetic resonance images representing the stage of disease and response to steroid treatment are presented. (C) 2004 Elsevier Inc. All rights reserved.