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Presentation Title Here (Example: Chronic ADEM)

Presentation Title Here (Example: Chronic ADEM). Name: _____________ Date: ______. History. Age: _______ Sex: _______ Disease History Example Previously healthy t eenager Prone to migraines. Please remember to de-identify your slides and remove identifying patient information.

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Presentation Title Here (Example: Chronic ADEM)

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  1. Presentation Title Here(Example: Chronic ADEM) Name: _____________ Date: ______

  2. History • Age: _______ • Sex: _______ • Disease History • Example • Previously healthy teenager • Prone to migraines Please remember to de-identify your slides and remove identifying patient information.

  3. Initial Presentation of Symptoms • Example: • Admitted through the ER on 08/16 • Headache, fatigue, light headedness, confusion, visual difficulties, etc. Please remember to de-identify your slides and remove identifying patient information.

  4. MRI of Initial Scan Please remember to de-identify your slides and remove identifying patient information.

  5. Additional Tests/Results • Examples: • CSF Test Results • NMO Testing • Any other relevant medical tests performed. Please remember to de-identify your slides and remove identifying patient information.

  6. Continuing Symptoms • Returning Date: _________ • Example: • Pupillary findings no longer present. • MRI with ongoing inflammation in same distribution. • 1 week of fatigue, poor concentration, etc. Please remember to de-identify your slides and remove identifying patient information.

  7. Other MRI Scans Please remember to de-identify your slides and remove identifying patient information.

  8. Impressions/ Diagnosis and Treatment • Example: • Prolonged ADEM? • MS? • NMO? • Other? Please remember to de-identify your slides and remove identifying patient information.

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