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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 6  |  Page : 1623

Radiological Evidence of Myelitis in Neuromyelitis Optica Spectrum Disorder: Bright Spotty Lesions


1 Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
2 Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

Date of Submission30-Jun-2019
Date of Decision18-Jul-2019
Date of Acceptance25-Jul-2021
Date of Web Publication23-Dec-2021

Correspondence Address:
Dr. Mi-Yeon Eun
Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.333494

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How to cite this article:
Seok HY, Eun MY. Radiological Evidence of Myelitis in Neuromyelitis Optica Spectrum Disorder: Bright Spotty Lesions. Neurol India 2021;69:1623

How to cite this URL:
Seok HY, Eun MY. Radiological Evidence of Myelitis in Neuromyelitis Optica Spectrum Disorder: Bright Spotty Lesions. Neurol India [serial online] 2021 [cited 2022 Jan 19];69:1623. Available from: https://www.neurologyindia.com/text.asp?2021/69/6/1623/333494




A previously healthy 22-year-old woman presented with three weeks of numbness in both hands, loss of sensation below the T5 level, brisk reflexes, and gait ataxia. Spinal magnetic resonance imaging (MRI) showed longitudinally extensive transverse myelitis (LETM) with bright spotty lesions extending from C1 to T7 [Figure 1]. Although she had no visual disturbances and had no prior history of optic neuritis, visual evoked potentials showed marked bilateral delayed P100 latencies (right: 149.7 ms; left: 128.7 ms). In addition to LETM with bright spotty lesions, female gender and asymptomatic visual evoked potential abnormality led us to raise suspicion of neuromyelitis optica spectrum disorder (NMOSD). Serum anti-aquaporin-4 antibody was strongly positive (intensity: 4+; range: 1+ to 4+). The patient met the 2015 revised diagnostic criteria for NMOSD by having one core clinical characteristic (acute myelitis) and positive anti-aquaporin-4 antibody.[1] Treatment with high-dose methylprednisolone produced a significant improvement of the symptoms. Bright spotty lesions, which have a signal intensity equal to or higher than the surrounding cerebrospinal fluid on T2-weighted axial images, are one of the specific MRI features of LETM suggesting NMOSD.[2],[3] These distinctive lesions, which appear in the acute phase of myelitis, are believed to reflect necrotic and microcystic changes but the exact pathophysiology is unknown.[3]
Figure 1: Spinal MRI of the patient (a) Sagittal T2-weighted image shows longitudinally extensive transverse myelitis with bright spotty lesions. (b-d) Axial T2-weighted images show punctate or larger bright spotty lesions (arrows) in the central and peripheral areas. The levels of the axial images are shown in the sagittal image

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  References Top

1.
Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015;85:177-89.  Back to cited text no. 1
    
2.
Hyun JW, Kim SH, Jeong IH, Lee SH, Kim HJ. Bright spotty lesions on the spinal cord: An additional MRI indicator of neuromyelitis optica spectrum disorder? J Neurol Neurosurg Psychiatry 2015;86:1280-2.  Back to cited text no. 2
    
3.
Dutra BG, da Rocha AJ, Nunes RH, Maia ACMJ. Neuromyelitis optica spectrum disorders: Spectrum of MR imaging findings and their differential diagnosis. Radiographics 2018;38:169-93.  Back to cited text no. 3
    


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