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MOG antibody associated disease (MOGAD) presenting with extensive brain stem encephalitis: A case report
Elisabeth Olbert1,2, Cornelia Brunner1,2, Naela Alhani1,2
1Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria.
Eneurologicalsci
|November 17, 2022
Summary
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) can affect the brainstem, a rare presentation. Early MOG antibody testing and treatment with steroids and immunoglobulins are recommended for suspected brainstem encephalitis.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is an emerging demyelinating disorder.
- Clinical manifestations include optic neuritis, transverse myelitis, and encephalic symptoms.
- Radiological findings typically involve cerebral/spinal lesions, cortical involvement, leptomeningeal enhancement, or tumefactive lesions.
Observation:
- A 30-year-old male presented with fever, impaired consciousness, nystagmus, singultus, and tetraparesis.
- MRI revealed extensive brainstem edema affecting cerebellar peduncles and pons.
- Diagnosis of MOGAD confirmed by positive MOG-specific antibodies in serum and CSF.
Findings:
- Brainstem involvement in MOGAD is infrequent but significant.
- Treatment with intravenous corticosteroids and immunoglobulins led to complete MRI resolution.
- The patient experienced delayed but nearly complete clinical recovery.
Implications:
- Consider MOGAD in cases of unexplained brainstem encephalitis.
- Testing for MOG antibodies is crucial for diagnosis.
- Prompt treatment with steroids and immunoglobulins is suggested for positive cases.
Keywords:
AB, antibodyADC, apparent diffusion coefficientADEM, acute demyelinating encephalomyelitisBrainstem encephalitisCLIPPERS, Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroidsCNS, cerebral nervous systemCSF, cerebrospinal fluidCase reportDW, diffusion weightedIVIG, intravenous immunoglobulinLETM, longitudinal extensive transverse myelitisLP, lumbal punctureMOG antibody encephalitisMOG, myelin oligodendrocyte glycoproteinMOG-AB, myelin oligodendrocyte glycoprotein antibodyMOGAD, myelin oligodendrocyte glycoprotein antibody diseaseMRI, magnetic resonance imagingMS, multiple sclerosisNMOSD, neuromyelitis optica spectrum disorderOCB, oligoclonal bandsT2w, T2 weightedceT1w, contrast enhanced T1 weightedMore Related Videos
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