Cortical and leptomeningeal involvement in three cases of neuromyelitis optica

MS Center, Utano National Hospital, Kyoto Department of Radiology, Shiga University of Medical Science, Shiga Department of Neurology, Kanazawa Medical University, Ishikawa, Japan.
European Journal of Neurology (Impact Factor: 4.06). 05/2012; 19(5):e47-8. DOI: 10.1111/j.1468-1331.2012.03667.x
Source: PubMed
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    ABSTRACT: Neuromyelitis optica (NMO), or Devic's disease, is a rare demyelinating disorder of the central nervous system that has a predilection for the optic nerve and spinal cord. Magnetic resonance imaging (MRI) is required to diagnose NMO. Longitudinally extensive transverse myelitis is NMO's imaging hallmark and the presence of a brain MRI that is not diagnostic of multiple sclerosis (MS) also remains part of the diagnostic criteria. It is increasingly recognised that MS and NMO brain imaging can, however, have similar appearances but differences do exist: hypothalamic, periaqueductal grey and area postrema lesions implicate NMO whilst cortical, U-fibre or Dawson's finger lesions are suggestive of MS. The timing of image acquisition, age, ethnicity and aquaporin-4 antibody status are all likely to alter the findings at MRI. This review therefore aims to overview and update the reader on NMO imaging, to provide clinically relevant guidance for diagnosing NMO and differentiating it from MS in order to guide management, and to highlight recent research insights.
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    ABSTRACT: Abstract Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system that usually presents with acute myelitis and/or optic neuritis. Recently some brain magnetic resonance imaging (MRI) findings have been described in NMO that are important in the differential diagnosis. Pencil-thin, leptomeningeal and cloud-like enhancement may be specific to NMO. These patterns are usually seen during relapses. Recognizing these lesions and enhancement patterns may expedite the diagnosis and allows early effective treatment. The purpose of this article is to review the latest knowledge and to share our experience with the contrast enhancement patterns of NMO brain lesions.
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