Conus medullaris involvement in demyelinating disorders of the CNS: A comparative study

Etemadifar, Masoud; Salari, Mehri; Kargaran, Parisa K; Sigari, Amirhossein Akhavan; Nouri, Hosein; Etemadifar, Fatemeh; Ebrahimi, Sara Honarmand; Sayahi, Newsha; Sedaghat, Nahad

doi:10.1016/j.msard.2021.103127

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…Severe visual deficiency (Snellen score < 20/200 for high-contrast visual acuity) during acute attacks is frequent in AQP4-IgG-positive NMOSD (and MOG-EM/MOGAD) but rare in MS. Whereas persistent severe motor impairment after acute myelitis is more suggestive of AQP4-IgG-positive NMOSD than of MOG-EM/MOGAD, persisting sphincter disturbance/sexual dysfunction is more commonly seen in MOG-EM/MOGAD, as the latter disorder more often affects the conus than does NMOSD [ 36 ]. While significant chronic progressive deterioration of symptoms independent of or in addition to clinical relapses frequently occurs in MS, such a course of disease is highly atypical and should be considered a red flag in NMOSD [ 231 ] (as well as MOG-EM/MOGAD [ 84 ]).…”

Section: When To Consider Nmosd?—clinical Characteristicsmentioning

confidence: 99%

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Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis

et al. 2023

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The term ‘neuromyelitis optica spectrum disorders’ (NMOSD) is used as an umbrella term that refers to aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica (NMO) and its formes frustes and to a number of closely related clinical syndromes without AQP4-IgG. NMOSD were originally considered subvariants of multiple sclerosis (MS) but are now widely recognized as disorders in their own right that are distinct from MS with regard to immunopathogenesis, clinical presentation, optimum treatment, and prognosis. In part 1 of this two-part article series, which ties in with our 2014 recommendations, the neuromyelitis optica study group (NEMOS) gives updated recommendations on the diagnosis and differential diagnosis of NMOSD. A key focus is on differentiating NMOSD from MS and from myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD), which shares significant similarity with NMOSD with regard to clinical and, partly, radiological presentation, but is a pathogenetically distinct disease. In part 2, we provide updated recommendations on the treatment of NMOSD, covering all newly approved drugs as well as established treatment options.

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Section: When To Consider Nmosd?—clinical Characteristicsmentioning

confidence: 99%

“…The mean upper cervical cord area may be reduced (AQP4-IgG-positive NMOSD > MOG-EM/MOGAD) [ 25 ]. Involvement of the lumbar spinal cord and the conus is less common in AQP4-IgG-positive NMOSD and MS, so its presence favors MOG-EM/MOGAD [ 36 ].…”

Section: Practical Recommendations On Imaging—mrimentioning

confidence: 99%

Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis

et al. 2023

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“…A straight T2 hyperintense line with surrounding hyperintense signal in the anterior and posterior gray matter horns on sagittal view can also be seen in MOGAD myelitis and is known as pseudo dilation of the central canal (23). The conus medullaris can be affected in about 26% of patients with MOGAD (24), which is a valuable radiographic clue, as the conus medullaris is less frequently affected in other demyelinating conditions, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), with rates of involvement as low as 1.3 and 6%, respectively, (8,(24)(25)(26). Gadolinium enhancement can occur in about half of patients with MOGAD myelitis and can be heterogeneous giving a cloud-like appearance (2, Clinically silent new lesions on MRI are rare and occur in only 3% of patients with MOGAD (21,27).…”

Section: Radiological Features Of Mogad Myelitismentioning

confidence: 99%

Transverse myelitis in myelin oligodendrocyte glycoprotein antibody-associated disease

2023

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Transverse myelitis (TM) is the second most common presentation of myelin oligodendrocyte antibody-associated disease (MOGAD), occurring in approximately 26% of affected patients. The diagnosis may be complicated by the lack of diagnostic specificity of low titers of MOG antibody in serum, fluctuation in seropositivity overtime, including initially normal MRI in up to 10% of patients, and in many instances complete resolution of radiological abnormalities when MRI is done in a significantly delayed fashion. The use of preventive disease modifying treatments is limited by the uncertainty whether the disease process will remain monophasic or become relapsing, as well as by the lack FDA approved treatments. In this review, we discuss clinical, radiological and cerebrospinal fluid (CSF) characteristics, including the significance of MOG titers and changes in the seropositivity status for the diagnosis of MOGAD-associated TM, its radiological features and management options, highlighting the data on the risk of relapses associated with TM at presentation and the need for further randomized clinical trials to empower effective treatment algorithms.

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“…Conus lesions were detected in 21%–41% cases of MOG-IgG myelitis, which is a higher prevalence than in AQP4-IgG myelitis (2%–13%) and MS myelitis (1%–33%). 40 41 42 43 57 58 A recent investigation of the diagnostic value of conus lesions found that affected patients had a 13-fold higher probability of being diagnosed with MOGAD than did those without a conus lesion. 58 This conus involvement may be associated with a high frequency of sphincter dysfunction in MOG-IgG myelitis patients.…”

Section: Mri Findings In Mog-igg Myelitismentioning

confidence: 99%

“… 40 41 42 43 57 58 A recent investigation of the diagnostic value of conus lesions found that affected patients had a 13-fold higher probability of being diagnosed with MOGAD than did those without a conus lesion. 58 This conus involvement may be associated with a high frequency of sphincter dysfunction in MOG-IgG myelitis patients. 41 In addition, several MOG-IgG myelitis cases with lumbosacral root thickening and enhancements have been reported, usually accompanied by conus lesions.…”

Section: Mri Findings In Mog-igg Myelitismentioning

confidence: 99%

Clinical and Radiological Features of Myelin Oligodendrocyte Glycoprotein-Associated Myelitis in Adults

Kim

Hyun

et al. 2022

J Clin Neurol

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Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have recently been established as a biomarker for MOG-antibody-associated disease (MOGAD), which is a distinct demyelinating disease of the central nervous system. Among the diverse clinical phenotypes of MOGAD, myelitis is the second-most-common presentation in adults, followed by optic neuritis. While some features overlap, there are multiple reports of distinctive clinical and radiological features of MOG-IgG-associated myelitis, which are useful for differentiating MOGAD from both multiple sclerosis and neuromyelitis optica spectrum disorder. In this review we summarize the clinical and radiographic characteristics of MOG-IgG-associated myelitis with a particular focus on adult patients.

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Conus medullaris involvement in demyelinating disorders of the CNS: A comparative study

Cited by 11 publications

References 17 publications

Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis

Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis

Transverse myelitis in myelin oligodendrocyte glycoprotein antibody-associated disease

Clinical and Radiological Features of Myelin Oligodendrocyte Glycoprotein-Associated Myelitis in Adults

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