Myelin oligodendrocyte glycoprotein antibody-associated aseptic meningitis without neurological parenchymal lesions: A novel phenotype

Meningo-cortical manifestations of myelin oligodendrocyte glycoprotein antibody-associated disease: Review of a novel clinico-radiographic spectrum

“…In keeping with meningeal inflammation all patients had CSF pleocytosis, and elevated CSF opening pressure was documented in the four who had this measured. Clinically, all had headache and/or fever, while only one-third had seizures; the clinical symptoms reported in MOGAM were therefore similar to those observed in cortical presentations of MOGAD, but with expected differences in relative frequencies that likely relate to whether involvement of the meninges or cortex predominates ( 12 , 24 ). Excellent response to corticosteroid was generally observed in patients with MOGAM, further supporting the notion that it exists on a broader spectrum of meningo-cortical manifestations in MOGAD.…”

“…Although initially reported to be a unilateral cortical encephalitis, we noted the presence of bilateral cortical involvement and possible meningeal inflammation in a subset of cases that was suggestive of a broader disease spectrum. In recent years, this possibility has been supported by the dramatic rise in reports of anti-MOG-positive patients with a variety of cortical and meningeal presentations ( 19 – 24 ). We herein review these meningo-cortical manifestations of MOGAD, with the aim of facilitating their prompt recognition when encountered in clinical practice.…”

“…These reports indicate that predominantly meningeal involvement falls on the continuum of meningo-cortical manifestations observed in MOGAD ( 34 , 60 , 61 ). This was emphasized in a review of twelve patients with MOG antibody positivity and aseptic meningitis in the absence of brain parenchymal lesions, which the authors referred to as MOG antibody-associated aseptic meningitis (MOGAM) ( 24 ). In keeping with meningeal inflammation all patients had CSF pleocytosis, and elevated CSF opening pressure was documented in the four who had this measured.…”

Criteria for myelin oligodendrocyte glycoprotein antibody‐associated disease: Balancing underdiagnosis with overdiagnosis

“…In this clinical setting, MOG antibody-associated aseptic meningitis is the most reasonable diagnosis. 2,3 However, these patients are unlikely to be diagnosed with MOGAD according to the new criteria, given that meningitis does not fit into any of the six defined phenotype classifications. In another scenario, a few patients with seizures (a relatively common presentation in MOGAD 4 ) may have normal brain MRI (especially at the disease onset), 5 and may not sufficiently fulfil the new criteria, which can affect the early diagnosis of MOGAD, thus delaying immunotherapy.…”

“…For instance, some patients, who clearly tested positive for serum MOG‐IgG, presented with fever, headache, and leptomeningeal enhancement on brain magnetic resonance imaging (MRI). In this clinical setting, MOG antibody‐associated aseptic meningitis is the most reasonable diagnosis 2,3 . However, these patients are unlikely to be diagnosed with MOGAD according to the new criteria, given that meningitis does not fit into any of the six defined phenotype classifications.…”