title: Occurrence of Asymptomatic Acute Neuromyelitis Optica Spectrum Disorder-Typical Brain Lesions during an Attack of Optic Neuritis or Myelitis.
abstract: We aimed to investigate the frequency of asymptomatic acute brain MRI abnormalities accompanying optic neuritis (ON) or myelitis in neuromyelitis optica spectrum disorder (NMOSD) patients with aquaporin-4 antibodies (AQP4-Ab). We reviewed 324 brain MRI scans that were obtained during acute attacks of ON or myelitis, in 165 NMOSD patients with AQP4-Ab. We observed that acute asymptomatic NMOSD-typical brain lesions accompanied 27 (8%) acute attacks of ON or myelitis in 24 (15%) patients. The most common asymptomatic brain abnormalities included edematous corpus callosum lesions (n = 17), followed by lesions on the internal capsule and/or cerebral peduncle lesions (n = 9), periependymal surfaces of the fourth ventricle (n = 5), large deep white matter lesions (n = 4), periependymal cerebral lesions surrounding the lateral ventricles (n = 3), and hypothalamic lesions (n = 1). If asymptomatic NMOSD-typical brain abnormalities were considered as evidence for DIS, while also assuming that the AQP4-IgG status was unknown, the median time to diagnosis using the 2015 diagnosis criteria for NMOSD was shortened from 28 months to 6 months (p = 0.008). Asymptomatic acute NMOSD-typical brain lesions can be accompanied by an acute attack of ON or myelitis. Identifying these asymptomatic brain lesions may help facilitate earlier diagnosis of NMOSD.
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea.
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea.
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Hyun
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea.
authors.forename: AeRan
authors.initials: A
authors.lastname: Joung
authors.affiliation: Department of Radiology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea.
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology; D001921:Brain / Q000000981:diagnostic imaging* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000000981:diagnostic imaging* / Q000276:immunology; D009471:Neuromyelitis Optica / Q000000981:diagnostic imaging* / Q000276:immunology; D009902:Optic Neuritis / Q000000981:diagnostic imaging* / Q000276:immunology; D055815:Young Adult
chemical_list: D051401:Aquaporin 4; D007074:Immunoglobulin G