Hyperperfusion Improvement: A Potential Therapeutic Marker in Neuromyelitis Optica Spectrum Disorder (NMOSD)

Area of Science:

• Neurology
• Immunology
• Radiology

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease affecting the central nervous system.
• Vaccination can sometimes trigger autoimmune conditions, necessitating careful diagnostic evaluation.
• Contrast-enhanced MRI is standard for NMOSD, but contraindications exist.

Purpose of the Study:

• To report a case of NMOSD following influenza vaccination.
• To investigate the utility of arterial spin labeling (ASL) MRI in diagnosing NMOSD when contrast agents are contraindicated.
• To discuss diagnostic challenges and management of vaccine-associated NMOSD.

Main Methods:

• Case report of a 70-year-old woman with post-vaccination neurological symptoms.
• Cerebrospinal fluid (CSF) analysis for demyelination markers.
• Brain MRI including diffusion-weighted imaging (DWI), T2-fluid attenuated inversion recovery (T2-FLAIR), and arterial spin labeling (ASL).
• Anti-aquaporin-4 antibody (AQP4-Ab) testing via ELISA and cell-based assay.

Main Results:

• Patient presented with ataxia and sensory deficits post-vaccination, initially suspected as acute disseminated encephalomyelitis (ADEM).
• Brain MRI revealed pontine hyperintensities and hyperperfusion on ASL.
• CSF showed oligoclonal bands and elevated myelin basic protein.
• Cell-based assay confirmed positive AQP4-Ab, diagnosing NMOSD.
• Symptoms improved with methylprednisolone, and ASL hyperperfusion resolved.

Conclusions:

• Arterial spin labeling (ASL) MRI may serve as a valuable diagnostic tool for NMOSD in patients with contraindications to contrast agents.
• Early diagnosis and treatment of NMOSD are crucial for favorable outcomes.
• Influenza vaccination can be a potential trigger for NMOSD, warranting further investigation.