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January 2009

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

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.