Enhancing Brain Lesions during Acute Optic Neuritis and/or Longitudinally Extensive Transverse Myelitis May Portend a Higher Relapse Rate in Neuromyelitis Optica Spectrum Disorders

Orman, Güneş; Wang, K.Y.; Pekçevik, Yeliz; Thompson, Carol B.; Mealy, Maureen A.; Lévy, Michaël; Izbudak, Izlem

doi:10.3174/ajnr.a5141

Cited by 11 publications

(9 citation statements)

References 44 publications

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“…Patterns of Enhancement.-Enhancement on T1-weighted images is detected in 9%-36% of NMOSD patients (38). Enhanced brain lesions in NMOSD have been associated with higher relapse rates when these MR imaging features are depicted at follow-up within 1 month of diagnosis of acute optic neuritis or LETM (59). The most common pattern of gadolinium enhancement is cloud-like, which is characterized as patchy and inhomogeneous with poorly defined margins ( Fig 8a) (38,51,55,60).…”

Section: Mr Imagingmentioning

confidence: 99%

Neuromyelitis Optica Spectrum Disorders: Spectrum of MR Imaging Findings and Their Differential Diagnosis

et al. 2018

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Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder for which the aquaporin-4 (AQP4) water channels are the major target antigens. Advances in the understanding of NMO have clarified several points of its pathogenesis, clinical manifestations, and imaging patterns. A major advance was the discovery of the AQP4 antibody, which is highly specific for this disorder. Descriptions of new clinical and radiologic features in seropositive patients have expanded the spectrum of NMO, and the term NMO spectrum disorder (NMOSD) has been adopted. NMOSD is now included in a widening list of differential diagnoses. Acknowledgment of NMOSD imaging patterns and their mimicry of disorders has been crucial in supporting early NMOSD diagnosis, especially for unusual clinical manifestations of this demyelinating disease. This pictorial review summarizes the wide imaging spectrum of NMOSD and its differential diagnosis, as well as its historical evolution, pathophysiology, and clinical manifestations. RSNA, 2018.

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Section: Mr Imagingmentioning

confidence: 99%

Neuromyelitis Optica Spectrum Disorders: Spectrum of MR Imaging Findings and Their Differential Diagnosis

et al. 2018

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“…Expansion and T1 hypointensity are common features in the acute attack of demyelinating/inflammatory entities as contrast enhancement. 23,24 Different patterns of contrast enhancement have been identified in NMOSD, such as cloudlike parenchymal, pencil-thin ependymal, leptomeningeal, or perivascular enhancement. [24][25][26][27][28] Among these, ependymal and leptomeningeal enhancement was found significantly more frequently in patients with NMOSD than in those with MS and was suggested as a characteristic feature in NMOSD.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Different patterns of contrast enhancement have been identified in NMOSD, such as cloudlike parenchymal, pencil-thin ependymal, leptomeningeal, or perivascular enhancement. [24][25][26][27][28] Among these, ependymal and leptomeningeal enhancement was found significantly more frequently in patients with NMOSD than in those with MS and was suggested as a characteristic feature in NMOSD. 27 In our study, we found similar results regarding leptomeningeal enhancement; it was seen in 3 patients (37.5%) with NMOSD and was not detected in patients with ADEM (P ϭ .23).…”

Section: Discussionmentioning

confidence: 99%

Brain MRI Findings in Pediatric-Onset Neuromyelitis Optica Spectrum Disorder: Challenges in Differentiation from Acute Disseminated Encephalomyelitis

Bulut¹,

Karakaya

Salama

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Differentiating pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis could be challenging, especially in cases presenting with only brain manifestations. Our purpose was to investigate brain MR imaging features that may help distinguish these 2 entities. MATERIALS AND METHODS:We retrospectively examined initial brain MR imaging studies of 10 patients with pediatric-onset neuromyelitis optica spectrum disorder (female/male ratio, 7:3) and 10 patients with acute disseminated encephalomyelitis (female/male ratio, 2:8). The mean age of the patients was 10.3 Ϯ 5.6 and 8.7 Ϯ 5.3 years, respectively. Brain lesions were evaluated with respect to location, extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. The 2 test (Yates or Fisher exact 2 tests) was used to compare differences between groups. RESULTS:Cerebral subcortical Ϯ juxtacortical and pons Ϯ middle cerebellar peduncle were the most frequent locations involved in both neuromyelitis optica spectrum disorder (n ϭ 5 and 4, respectively) and acute disseminated encephalomyelitis (n ϭ 9 and 7, respectively). Thalamic lesions were more frequent in acute disseminated encephalomyelitis (P ϭ .020) and were detected only in 1 patient with neuromyelitis optica spectrum disorder. None of the patients with neuromyelitis optica spectrum disorder had hypothalamic, internal capsule, or cortical lesions. The internal capsule involvement was found to be significantly different between groups (P ϭ .033). There was no significant difference in terms of extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. CONCLUSIONS:Although there is a considerable overlap in brain MR imaging findings, thalamic and internal capsule involvement could be used to differentiate pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis. ABBREVIATIONS: ADEM ϭ acute disseminated encephalomyelitis; anti-AQP4 ϭ anti-aquaporin-4; AQP4 ϭ aquaporin-4; NMOSD ϭ neuromyelitis optica spectrum disorder

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“…Atypical ON can be part of the neuromyelitis optica spectrum (NMO), 27 corticosteroid-dependent chronic relapsing inflammatory optic neuropathy (CRION), and systemic diseases such as sarcoidosis, connective tissue diseases (systemic lupus erythematosus, Sjögren's syndrome, and polyarteritis nodosa), and vasculitis (Wegener's granulomatosis). 25,28,29 Others are infectious causes such as Lyme disease, neurosyphilis, tuberculosis, HIV, cytomegalovirus, varicella zoster, toxoplasmosis, and cryptococcosis, among others.…”

Section: Medical Imaging Findingsmentioning

confidence: 99%

A bilateral optic neuritis side effect of biological treatment with pembrolizumab in a patient with metastatic melanoma

Nassar¹,

Rivera²,

Mora³

et al. 2020

JNSK

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Pembrolizumab is an anti-PD-1 humanized monoclonal antibody, standardized therapy for the treatment of metastatic melanoma, providing an overall survival benefit to patients; however, it may be associated with immune-related adverse effects (irAE). We describe the case of a patient with a history of metastatic melanoma undergoing treatment with pembrolizumab, who presented visual acuity deterioration due to inflammatory involvement of the optic nerves. There are few reported cases of an optic neuritis side effect of treatment with immune checkpoint inhibitors. The patient received high doses of steroids and plasmapheresis with improved light perception. This case highlights the need to recognize atypical processes, mediated by the immune system, associated with treatment with immune checkpoint inhibitors (ICI), including pembrolizumab.

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Enhancing Brain Lesions during Acute Optic Neuritis and/or Longitudinally Extensive Transverse Myelitis May Portend a Higher Relapse Rate in Neuromyelitis Optica Spectrum Disorders

Cited by 11 publications

References 44 publications

Neuromyelitis Optica Spectrum Disorders: Spectrum of MR Imaging Findings and Their Differential Diagnosis

Neuromyelitis Optica Spectrum Disorders: Spectrum of MR Imaging Findings and Their Differential Diagnosis

Brain MRI Findings in Pediatric-Onset Neuromyelitis Optica Spectrum Disorder: Challenges in Differentiation from Acute Disseminated Encephalomyelitis

A bilateral optic neuritis side effect of biological treatment with pembrolizumab in a patient with metastatic melanoma

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