Comprehensive Imaging Evaluation Found to Be Useful in NMOSD Case

Comprehensive Imaging Evaluation Found to Be Useful in NMOSD Case

Avatar photoÖzge Özkaya, MSc, PhD
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A team of researchers from India presented what they called an “aberrant” case of neuromyelitis optica spectrum disorder (NMOSD).

“Unusual findings in the present case highlight the importance of comprehensive imaging evaluation and raising awareness among clinicians and radiologists regarding the imaging spectrum of NMOSD,” they wrote in a report published in the journal Cureus.

Read more about the diagnosis of NMOSD

Only this way can patients receive a timely diagnosis and a treatment approach tailored to them, they noted.

The case is that of a 26-year-old female with recurrent weakness, pain, and sensory symptoms in the arms and legs. 

The patient was first treated for multiple sclerosis (MS) but later developed new symptoms, including blurred vision and ataxia. 

She underwent magnetic resonance imaging of the spine and brain. 

This revealed short-segment cervical cord involvement and a lesion in the conus medullaris, which is classically associated with myelin oligodendrocyte glycoprotein antibody-associated disease.

However, blood tests showed the patient had anti-aquaporin 4 (AQP4) antibodies, confirming a diagnosis of NMOSD, the investigators noted.

“Radiologists should be aware of this unusual finding while evaluating patients with demyelinating disorders, as the diagnosis is based on complete imaging features along with laboratory findings,” concluded the team, led by Ashwini Umredkar, MD, from the All India Institute of Medical Sciences Nagpur in India.

NMOSD is a rare demyelinating disease characterized by optic neuritis and myelitis. Although it shares similarities with MS, it is a different entity. Most patients with NMOSD have autoantibodies against the AQP4 water channel found on astrocytes. However, some patients may have autoantibodies against MOG. 

Regarding imaging findings, longitudinally extensive spinal cord lesions, optic neuritis mainly affecting the posterior aspect of optic nerves, and optic radiations are common in NMOSD, where the brain parenchymal lesions mainly affect the area postrema.

Reference

Dhok A, Ratnaparkhi C, Kumar S, et al. An aberrant case of neuromyelitis optica spectrum disorder with a review of literature. Cureus. Published online May 6, 2024. doi:10.7759/cureus.59765