In their recent article, Eichel et al1 report that in contrast to acute disseminated encephalomyelitis (ADEM), brain lesions in neuromyelitis optica (NMO) lack gadolinium enhancement. We report the case of a 37-year-old woman with a rapidly progressive spinal cord syndrome resulting in paraplegia, sensory disturbance, and urinary retention. Magnetic resonance imaging revealed multiple lesions in the cerebrum, pons, medulla, cerebellum, and spinal cord, including a longitudinally extensive lesion from C6/7 to T2/3. Several brain and cord lesions showed gadolinium enhancement. Cerebrospinal fluid analysis revealed 50 lymphocytes/μL and oligoclonal bands were absent; an initial diagnosis of ADEM was made. Interval imaging at 9 months revealed resolution of the cranial lesions. However, the patient subsequently developed severe optic neuritis that prompted testing for the aquaporin 4 antibody. The results were positive.
Gilmore CP, Jacob A, Evangelou N. A Case of Neuromyelitis Optica With Gadolinium-Enhancing Brain Lesions and Parinaud Syndrome. Arch Neurol. 2009;66(1):138-141. doi:10.1001/archneurol.2008.520