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Cerebrovascular risk factors impact on brain atrophy and DTI-ALPS decrease in neuromyelitis optica spectrum disorder.

Martina Rubin1,2,3, Paolo Preziosa1,2,3, Monica Margoni1,2,4

  • 1Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Journal of Neurology
|May 23, 2026
PubMed
Summary
This summary is machine-generated.

Cerebrovascular risk factors worsen brain damage and disability in neuromyelitis optica spectrum disorder (NMOSD). These factors amplify the impact of impaired neurofluid dynamics, indicating combined vascular and astrocytic injury in NMOSD.

Keywords:
Brain atrophyCerebrovascular risk factorsDTI-ALPSMRINeuromyelitis optica spectrum disorder

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Area of Science:

  • Neuroimmunology
  • Neuroimaging
  • Vascular Neurology

Background:

  • Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease causing significant disability, primarily driven by relapses.
  • Cerebrovascular risk factors (cVRFs) may worsen the astrocytic and small-vessel damage characteristic of NMOSD.

Purpose of the Study:

  • To investigate the impact of cVRFs on MRI-detected central nervous system (CNS) damage.
  • To determine the association between cVRFs, MRI findings, and clinical disability in NMOSD patients.

Main Methods:

  • Aquaporin 4 immunoglobulin G-positive NMOSD patients and healthy controls underwent 3T MRI, neurological assessments, and cVRF evaluation.
  • Quantified MRI metrics included white matter lesion volume, normalized brain and deep gray matter volumes, and diffusion tensor imaging analysis along the perivascular spaces (DTI-ALPS).

Main Results:

  • NMOSD patients exhibited higher brain white matter lesion volume and spinal cord lesion volume compared to controls.
  • Significant interactions between diagnosis and cVRFs were observed for normalized deep gray matter volume and DTI-ALPS.
  • In NMOSD, higher disability (Expanded Disability Status Scale) correlated with lower DTI-ALPS and higher spinal cord lesion volume.

Conclusions:

  • Cerebrovascular risk factors exacerbate CNS damage in NMOSD.
  • cVRFs amplify the clinical impact of impaired neurofluid dynamics, suggesting a convergence of vascular and astrocytic injury in NMOSD pathogenesis.