Abstract
Background
Neuromyelitis optica (NMO), or neuromyelitis optica spectrum disorder (NMOSD), is an autoimmune CNS condition which often has a complex clinical course. Longitudinally extensive transverse myelitis (LETM) is an important and sensitive MRI finding but is not very specific to NMOSD and is seen in other causes of myelitis.
Case presentations
We report 11 NMO cases, all seen in women from 25 to 75 years at the time of diagnosis, with most above 65 years of age. All patients were seropositive for AQP4–IgG antibodies, and none had anti-MOG antibodies. Clinical presentations were diverse, the most common being paralytic and visual changes. In this study, 5 of the 11 seropositive NMO patients (45%) had bright spotty lesion (BSLs) on their MRI spine, as opposed to none (0%) in the control group. BSLs were defined as hyperintense foci of signal abnormality on T2-weighted images compared to the surrounding CSF. Treatment included symptomatic management and immunotherapy; timely management led to improvement in all the cases, with partial recovery seen in most (91%) and complete recovery seen only in one.
Conclusions
BSLs are a newly defined spinal MRI finding with high specificity, but low sensitivity for NMOSD. The absence of BSLs in the control group establishes its prolific role in distinguishing NMO from MS, ITM, MOGAD and other forms of myelitis. The main aim of this retrospective case–control study was to determine the diagnostic importance and specificity of bright spotty lesions (BSLs) in NMOSD and its ability to discriminate NMOSD from other causes of LETM.
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1 West Virginia University, Department of Neuroradiology, Morgantown, USA (GRID:grid.268154.c) (ISNI:0000 0001 2156 6140)
2 Malla Reddy Institute of Medical Sciences (MRIMS), Hyderabad, India (GRID:grid.268154.c)
3 McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, Houston, USA (GRID:grid.267308.8) (ISNI:0000 0000 9206 2401)
4 Sinai Grace Hospital, Department of Medicine, Detroit, USA (GRID:grid.413261.3) (ISNI:0000 0004 0396 5502)
5 Minia University, Department of Neuropsychiatry, Minya, Egypt (GRID:grid.411806.a) (ISNI:0000 0000 8999 4945)
6 Meditrina Institute of Medical Sciences, Nagpur, India (GRID:grid.411806.a)
7 West Virginia Clinical Translational Science, Morgantown, USA (GRID:grid.411806.a)
8 McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, Houston, USA (GRID:grid.267308.8) (ISNI:0000 0000 9206 2401); Sinai Grace Hospital, Department of Medicine, Detroit, USA (GRID:grid.413261.3) (ISNI:0000 0004 0396 5502); West Virginia Clinical Translational Science, Morgantown, USA (GRID:grid.413261.3)