Document Detail


Extensive hemispheric lesions with radiological evidence of blood-brain barrier integrity in a patient with neuromyelitis optica.
MedLine Citation:
PMID:  19497587     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Anti-aquaporin-4 antibody (NMO-IgG) is used as a diagnostic marker for neuromyelitis optica (NMO). Although the mechanism of spinal cord lesions in NMO has been investigated, that of extensive hemispheric lesions with brain edema remains unclear. Here we report a 36-year-old woman with NMO positive for NMO-IgG, who developed an acute disseminating encephalomyelitis (ADEM)-like episode after Mycoplasma pneumoniae infection. Brain MRI T2-weighted images demonstrated asymmetric tumefactive hyperintense lesions in the subcortical white matter. Importantly, no lesions on T1-weighted images were enhanced after intravenous gadolinium administration on serial brain MRIs, suggesting preserved integrity of the blood-brain barrier (BBB). Likewise, the corresponding apparent diffusion coefficient maps demonstrated persistent hyperintensity changes, which represented vasogenic edema associated with glial damage and consequent neuronal loss. The findings suggest possible involvement of deficient water elimination associated with seropositivity to NMO-IgG in the induction of vasogenic edema even in the presence of intact and functional BBB.
Authors:
Shinji Saiki; Yuji Ueno; Toshio Moritani; Takeshi Sato; Takeshi Sekine; Sumihiro Kawajiri; Satoshi Adachi; Kazumasa Yokoyama; Yuji Tomizawa; Yumiko Motoi; Nobutaka Hattori
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-06-03
Journal Detail:
Title:  Journal of the neurological sciences     Volume:  284     ISSN:  1878-5883     ISO Abbreviation:  J. Neurol. Sci.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-05     Completed Date:  2009-12-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375403     Medline TA:  J Neurol Sci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  217-9     Citation Subset:  IM    
Affiliation:
Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. ssaiki@juntendo.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aquaporin 4 / immunology*
Autoantibodies / immunology*
Autoantigens / immunology*
Blood-Brain Barrier
Brain Edema / etiology,  physiopathology
Contrast Media / pharmacokinetics
Diagnostic Errors
Diffusion Magnetic Resonance Imaging*
Encephalomyelitis, Acute Disseminated / etiology*,  physiopathology
Female
Gadolinium / diagnostic use,  pharmacokinetics
Humans
Interferon-beta / adverse effects,  therapeutic use
Magnetic Resonance Imaging
Multiple Sclerosis / diagnosis,  drug therapy
Mycoplasma pneumoniae
Myelitis, Transverse / etiology
Neuromyelitis Optica / diagnosis*,  immunology,  pathology,  radiography
Pneumonia, Mycoplasma / complications*
Chemical
Reg. No./Substance:
0/AQP4 protein, human; 0/Aquaporin 4; 0/Autoantibodies; 0/Autoantigens; 0/Contrast Media; 145155-23-3/interferon beta-1b; 7440-54-2/Gadolinium; 77238-31-4/Interferon-beta

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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