Brain bright spotty lesions and leukodystrophy-like patterns in NMOSD relapse

Neuromyelitis optica spectrum disorder (NMOSD) is a rare disease that primarily affects the optic nerve and the spinal cord but less frequently can also involve the brain. We present the case of a woman who experienced an atypical NMOSD relapse characterized by MRI white matter brain lesions with a leukodystrophy-like pattern. Additionally, lesions in the middle cerebellum peduncles exhibited a distinctive T2w hyperintense/FLAIR hypointense signal resembling the brain's bright spotty lesions (BSLs) previously described in the spinal cord. This case highlights the importance of recognizing atypical MRI patterns in NMOSD to facilitate diagnosis and appropriate timely treatment.