PMC9393544_01
MRI brain and whole spine T2/FLAIR images demonstrating (A) hyperintense T2/FLAIR signal in left corpus callosum, (B) hyperintense foci in left side of thoracic spinal cord (arrow), and (C) hyperintense signal seen in left optic nerve with chiasmal extension with significant atrophy of right optic nerve.
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F1
MRI brain and whole spine with gadolinium demonstrated a hyperintense T2/FLAIR signal with restricted diffusion in the left corpus callosum, as well as a hyperintense focus at the level of T5 that was also favored to represent demyelination, neither of which had evidence of active enhancement (Figure 1). High signal with enhancement was seen in the left optic nerve with chiasmal extension and the right optic nerve appeared to have significant atrophy (Figure 1).
Timeline of acute therapy administered during hospital admission. IVMP, intravenous methylprednisolone; PLEX, plasmapheresis.
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F2
Given the typical clinical history and presentation, positive serum AQP4-IgG and neuroradiological findings, the patient was diagnosed with a likely acute relapse of her NMOSD and commenced on pulse intravenous methylprednisolone (IVMP) 1 g once daily for 5 days (Figure 2).