Relevance of bright spotty lesions in neuromyelitis optica spectrum disorders (NMOSD): a case series

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.

Neuromyelitis Optica Mimicking Cervical Spondylotic Myelopathy

“…In cases of cord compression caused by disc herniation, it is common to observe spinal cord signal changes primarily in proximity to the site of compression. [5] However, in this case, despite the compression being located at C2-3, there were signal intensity change observed at C3-4, suggesting that the observed signal alteration may not be solely attributable to compression. While autoimmune diseases are commonly observed in individuals in their 50s, they have also been reported to occur in individuals in their 90s.…”

“…BSLs are considered a characteristic feature of NMOSD, distinguishing it from conditions such as multiple sclerosis (MS) and other disorder that revealed LETM. [5,8] if BSLs do not correlate with the level of compression, additional investigations should be conducted to consider the possibility of NMOSD.…”

Significant up-regulation of lncRNAs in neuromyelitis optica spectrum disorder

“…NMOSD lesions also cause frequent brain attacks by involving the brain stem. These attacks appear as optic neuritis, myelitis and some brainstem disorders 4 . NMOSD is a severe debilitating disorder that can lead to irreversible consequences, including everlasting blindness, paralysis or even demise 5 .…”