Background: Acute Disseminated Encephalomyelitis (ADEM) is an acute demyelinating syndrome of the CNS. Due to the non-specific diagnostic tools and presence of many demyelinating conditions that overlap with ADEM, there might be over estimation of cases of ADEM. Objective: The aim of the present study is the early detection and estimating the prevalence of ADEM in patients admitted to pediatric intensive care unit (ICU) with acute disturbance of consciousness. Patients and methods: A cross-sectional study was conducted on 66 children (36 males and 30 females) admitted to Pediatrics ICU at Zagazig University Hospitals fit to the inclusion criteria during the period between March 2021 and February 2022. Complete history was taken from all parents. Physical examination was done for each case and including mental status, cranial nerves, motor and sensory examination, coordination, reflexes, and gait. All patients also underwent magnetic resonance imaging, cerebrospinal fluid analysis, C-reactive protein, complete blood count, electrolytes (Na - K) and fundus examination. Results: According to MRI findings, lesions were typically asymmetrical (68.2%). The commonest distribution of lesion was cortical GM in 45.5% of cases followed by Juxtacortical WM in 31.8%. The commonest pattern was that of patchy (33.3%), followed by confluent/ larger areas seen in 24.2% of cases. Diffusion restriction and brain edema was presented in 31.8% and 33.3% respectively. Conclusion: Understanding the prevalence can help raise awareness of these illnesses in children because ADEM can be a difficult diagnosis. This is significant since there are signs that the incidence among children under the age of 12 may be rising.