Unrecognized neuromyelitis optica spectrum disorder with pontine and corpus callosum microhemorrhage
English
Abstract
Introduction. Neuromyelitis optica spectrum disorder (NMOSD) represents an immune-mediated neuroinflammatory syndrome, classified as a separate entity after the discovery of aquaporin-4 immunoglobulin G (anti-AQP4-IgG). The magnetic resonance neuroimaging spectrum of NMOSD classically consists of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM), recently broadened with lesions in area postrema, diencephalon, brainstem and cerebellum, and extensive cord atrophy. Case report. The case presents an anti-AQP4 autoantibody-positive 65-year-old female patient who initially presented with underestimated LETM and developed multiple cerebral and cerebellar lytic demyelinating lesions associated with acute long segment optic nerve involvement two years later. Two new imaging findings were described in this case: the involvement of a complete cross-sectional area of pons and microhemorrhage in the pons and corpus callosum. Conclusion. Raising suspicion of NMOSD is of crucial importance in cases with isolated LETM in order to prevent relapses in anti-AQP4-IgG positive cases and improve patient outcomes and recovery.
References
1. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International Panel for NMO Diagnosis. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85(2): 177‒89.
2. Wingerchuk DM. Evidence for humoral autoimmunity in neuromyelitis optica. Neurol Res 2006; 28(3): 348‒53.
3. Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock S, Weinshenker BG. The spectrum of neuromyelitis optica. Lancet Neurol 2007; 6(9): 805‒15.
4. Cabre P, González-Quevedo A, Bonnan M, Saiz A, Olindo S, Graus F, et al. Relapsing neuromyelitis optica: long term history and clinical predictors of death. J Neurol Neurosurg Psychiatry 2009; 80(10): 1162‒4.
5. Akaishi T, Nakashima I, Sato DK, Takahashi T, Fujihara K. Neuromyelitis Optica Spectrum Disorders. Neuroimaging Clin N Am 2017; 27(2): 251‒65.
6. Kim, SH, Hyun JW, Joung A, Lee SH, Kim HJ. Occurrence of asymptomatic acute neuromyelitis optica spectrum disorder-typical brain lesions during an attack of optic neuritis or myelitis. PLoS One 2016; 11(12): e0167783.
7. Trebst C, Jarius S, Berthele A, Paul F, Schippling S, Wildemann B, et al. Neuromyelitis Optica Study Group (NEMOS). Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol 2014; 261(1): 1‒16.
8. Zhu R, Liu X, He Z. Widely spread corticospinal tracts lesion in a case of neuromyelitis optica. Clin Neurol Neurosurg 2017; 161: 56‒8.
9. Lu Z, Zhang B, Qiu W, Kang Z, Shen L, Long Y, et al. Comparative brain stem lesions on MRI of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis. PLoS One 2011; 6(8): e22766.
10. Kamo H, Ueno Y, Sugiyama M, Miyamoto N, Yamashiro K, Tanaka R, et al. Pontine hemorrhage accompanied by neuromyelitis optica spectrum disorder. J Neuroimmunol 2019; 330: 19‒22.
11. Bozin I, Ge Y, Kuchling J, Dusek P, Chawla S, Harms L, et al. Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration. PLoS One 2015; 10(7): e0128386.