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Recurrent Stroke - Should We Think Beyond Ischemia? - Case of MOG Encephalitis

Ajay Nathan1, Bharat Rajkumar1, M Kasiviswanathan2

  • 1Department of Medicine, INHS Sanjivani, Kochi, Kerala, India.

Neurology India
|July 21, 2026
PubMed

Insights

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) can mimic stroke. Early diagnosis and immunotherapy in young adults with MOGAD are crucial for preventing misdiagnosis and improving outcomes.

Area of Science:

  • Neurology
  • Immunology
  • Neuroimmunology

Background:

  • Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a rare autoimmune demyelinating disorder.
  • MOGAD presents with diverse neurological symptoms and can be misdiagnosed as multiple sclerosis, neuromyelitis optica spectrum disorders, or cerebrovascular events.

Purpose of the Study:

  • To highlight the diagnostic challenges of MOGAD, particularly its mimicry of stroke.
  • To emphasize the importance of early recognition and appropriate immunotherapy for MOGAD.

Main Methods:

  • Case report of a 30-year-old male with recurrent neurological deficits.
  • Clinical presentation, neuroimaging findings (hyperintense lesions in pons and cerebellar peduncles), and MOG-IgG seropositivity.
  • Treatment with pulse corticosteroid therapy and maintenance immunosuppression with mycophenolate mofetil.

Main Results:

  • The patient initially presented with stroke-like symptoms (hemiplegia, facial palsy) and received thrombolysis.
  • Recurrent symptoms and neuroimaging led to the diagnosis of MOG encephalitis.
  • The patient showed significant improvement with immunotherapy and remained asymptomatic.

Conclusions:

  • MOGAD should be considered in young patients with recurrent neurological deficits and clinico-radiological dissociation.
  • Prompt diagnosis and immunotherapy can prevent unnecessary treatments like thrombolysis and improve patient outcomes.
  • Clinicians must maintain a high index of suspicion for MOGAD as a stroke mimic in atypical presentations.
Keywords:
Cerebellar ataxiaMOG antibody-associated diseaseclinico-radiological dissociationdemyelinating disorderstroke mimic

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