In reply
Gilmore and colleagues report the case of a 37-year-old woman with NMO-associated Parinaud syndrome. They compared this woman's case with that of the 13-year-old boy my colleagues and I described previously who presented with severe encephalopathy and confluent nonenhancing white matter lesions.1 They note that this woman's brain lesions showed gadolinium enhancement on magnetic resonance imaging and conclude that “gadolinium-enhancing brain lesions . . . may not be a reliable way of distinguishing NMO from ADEM.”