PMC7584942_01
T2WI of cervical and thoracic spine of a 31-year-old African American woman with NMOSD and SLE. In 2018, cervical (a) and thoracic spine (b) demonstrated a C6 hyperintense lesion extending to T8 (a, b), which was unchanged from a prior spine MRI of the patient (not shown). In 2019, there was a new C2-C4 longitudinal lesion noted on the C spine on T2WI (c) with associated patchy postcontrast enhancement on T1WI (d) and an ongoing hyperintense lesion in the T spine extending to T8 (e).
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MRI of the brain and total spine in 2015 and 2018 (Figure 1) showed stable C6-T8 myelomalacia with no active inflammation. Upon arrival, MRI with contrast of the brain, cervical, and thoracic spine revealed an acute enhancing lesion extending from C1 to C4 (Figure 1).
PMC7584942_02
FLAIR brain MRI of a 52-year-old African American woman with active SLE demonstrating edematous lesion in the brainstem (a) extending to the basal ganglia (b) at initial hospital presentation in July 2019. Edema and lesion size decreased posttreatment with methylprednisolone, PLEX, and cyclophosphamide (c) and (d) FLAIR fluid-attenuated inversion recovery.
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At this time, MRI brain demonstrated increased thalamocapsular and pontomesencephalic edema (Figure 2). MRI brain showed only slight improvement in previously noted lesions (Figure 2). MRI C/T spine remained normal without evidence of myelitis.
PMC7584942_03
FLAIR brain MRI of a 48-year-old Hispanic woman with SLE with noted medullary lesion extending to the periaqueductal gray matter (a, b) and with diffuse lesions in the C and T spine (c, d).
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Repeat MRI brain demonstrated new abnormal lower brainstem and periaqueductal gray signal abnormality; in retrospect, her clinical presentation was area postrema syndrome due to NMOSD (Figure 3).